| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD. STE 600 TORRANCE, CA 90503 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $48K | $5K | $53K | 11.06% |
| WELLS FARGO INSURANCE SERVICES3 | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $27K | $3K | $30K | 11.07% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD. STE 600 TORRANCE, CA 90503 | VISION SERVICE PLAN | $11K | — | $11K | 5.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $19K | $2K | $21K | 11.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $177 | $2K | 10.82% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICS USA | 21250 HAWTHORNE BLVD STE 600 TORRANCE, CA 90503 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $227 | $25 | $252 | 11.11% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD. STE 600 TORRANCE, CA 90503 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $155 | $19 | $174 | 11.20% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 2,583 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,606 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD PF HAWAII | 7 | $70K |
| Dental | BLUE CROSS BLUE SHIELD PF HAWAII | 7 | $70K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 1,789 | $290K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,583 | $553K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 875 | $270K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,583 | $189K |
| Prescription drug | BLUE CROSS BLUE SHIELD PF HAWAII | 7 | $70K |
| Other(5 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD PF HAWAII | 2,853 | $138K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,853 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.