| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $143 | $143 | 0.17% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY, INC. | 2305 RIVER ROAD, SUITE 300 LOUISVILLE, KY 40206 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 7.28% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | 320 W 57TH STREET, 3RD FLOOR NEW YORK, NY 10019 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $297 | $297 | 0.68% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY, INC. | 2305 RIVER ROAD, SUITE 300 LOUISVILLE, KY 40206 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $4K | — | $4K | 10.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | 320 W 57TH STREET, 3RD FLOOR NEW YORK, NY 10019 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $320 | $320 | 0.80% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY, INC. | 2305 RIVER ROAD, SUITE 300 LOUISVILLE, KY 40206 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $2K | — | $2K | 9.35% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | 320 W 57TH STREET, 3RD FLOOR NEW YORK, NY 10019 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $165 | $165 | 0.86% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY, INC. | 2305 RIVER ROAD, SUITE 300 LOUISVILLE, KY 40206 | VISION SERVICE PLAN | $994 | — | $994 | 5.89% |
| ASSUREDPARTNERS3 Filed as: ASSURED NL INSURANCE AGENCY, INC. | 2305 RIVER ROAD, SUITE 300 LOUISVILLE, KY 40206 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $682 | — | $682 | 15.01% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | 320 W 57TH STREET, 3RD FLOOR NEW YORK, NY 10019 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $55 | $55 | 1.21% |
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 | 450 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 455 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HAWAII MEDICAL SERVICE ASSOCIATION | 19 | $86K |
| Dental(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 462 | $320K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 148 | $103K |
| Life insurance | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 450 | $44K |
| Short-term disability | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 450 | $19K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 450 | $40K |
| Other(2 contracts) | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 450 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 462 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.