| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $3K | $3K | 1.57% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $3K | $3K | 1.57% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 1.57% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY LLC | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $529 | $529 | 1.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS CO EIN 59-1031071 THIRD-PARTY ADMINISTRATO | Claims processing; Direct payment from the plan; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Participant communication; Non-monetary compensation; Recordkeeping fees Service code 12 | — | $234K |
| STANDISH MELLON ASSET MGMT CO, LLC EIN 25-1890416 INVESTMENT MANAGER | Investment management fees paid directly by plan; Investment management; Direct payment from the plan Service code 28 | — | $126K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE, INV ADV & MGMT | Investment advisory (plan); Investment management fees paid directly by plan; Other fees; Trustee (directed); Account maintenance fees; Direct payment from the plan; Trustee (bank, trust company, or similar financial institution); Other investment fees and expenses; Float revenue; Investment management Service code 21 | — | $122K |
| WILLIS TOWERS WATSON EIN 26-0775680 HRA ADMINISTRATION | Other services; Other fees; Direct payment from the plan Service code 49 | — | $117K |
| KAISER FOUNDATION HEALTH PLAN OF HI EIN 94-1340523 THIRD-PARTY ADMINISTRATO | Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing; Recordkeeping fees; Participant communication Service code 12 | — | $99K |
| KPMG LLP EIN 13-5565207 PLAN AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $81K |
| ANTHEM HEALTH PLANS OF VIRGINIA, IN EIN 54-0357120 THIRD-PARTY ADMINISTRATO | Direct payment from the plan; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue Service code 12 | — | $53K |
| CROWE LLP EIN 35-0921680 FINANCIAL STATEMENT PREP | Consulting (general); Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $24K |
| EY EIN 34-6565596 TAX FORM PREPARER | Consulting (general); Direct payment from the plan Service code 16 | — | $21K |
| PRIME THERAPEUTICS LLC EIN 26-0076803 PHARMACY BENEFIT MANAGER | Direct payment from the plan; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Other services; Participant communication Service code 12 | — | $17K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 THIRD-PARTY ADMINISTRATO | Direct payment from the plan; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Other services; Participant communication Service code 12 | — | $7K |
| AON CONSULTING, INC. EIN 22-2232264 FORM 5500 PREPARER | Direct payment from the plan; Consulting (general) Service code 16 | — | $5K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 THIRD PARTY ADMINISTRATO | Float revenue; Other services Service code 49 | — | $0 |
| NORTHERN TRUST CORPORATION EIN 36-2723087 TRUSTEE | Other services; Soft dollars commissions; Investment management fees paid indirectly by plan Service code 49 | — | $0 |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4,496 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,496 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 87 | $467K |
| Vision | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 87 | $467K |
| Life insurance(5 contracts) | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 1,561 | $558K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 87 | $467K |
| Other | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 2 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,561 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.