| 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 | 1.52% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 1.52% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 1.52% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY LLC | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $401 | $401 | 1.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS CO EIN 59-1031071 THIRD-PARTY ADMINISTRATO | Contract Administrator; Participant communication; Other services; Recordkeeping fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Non-monetary compensation; Direct payment from the plan; Float revenue Service code 12 | — | $229K |
| WILLIS TOWERS WATSON EIN 26-0775680 HRA ADMINISTRATION | Direct payment from the plan; Other fees; Other services Service code 49 | — | $106K |
| KAISER FOUNDATION HEALTH PLAN OF HI EIN 94-1340523 THIRD-PARTY ADMINISTRATO | Direct payment from the plan; Other services; Claims processing; Contract Administrator; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees Service code 12 | — | $88K |
| KPMG LLP EIN 13-5565207 PLAN AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $83K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE, INV ADV & MGMT | Trustee (bank, trust company, or similar financial institution); Other investment fees and expenses; Trustee (directed); Investment advisory (plan); Investment management fees paid directly by plan; Investment management; Other fees; Float revenue; Direct payment from the plan; Account maintenance fees Service code 21 | — | $58K |
| ANTHEM HEALTH PLANS OF VIRGINIA, IN EIN 54-0357120 THIRD-PARTY ADMINISTRATO | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator; Float revenue; Other services; Claims processing Service code 12 | — | $52K |
| BNY MELLON EIN 13-5160382 INVESTMENT MANAGER | Investment management; Investment management fees paid directly by plan; Direct payment from the plan Service code 28 | — | $32K |
| BLACKROCK FINANCIAL MANAGEMENT, INC EIN 13-3806691 INVESTMENT MANAGER | Investment management fees paid directly by plan; Direct payment from the plan; Investment advisory (plan); Investment management Service code 27 | — | $29K |
| EY EIN 34-6565596 TAX FORM PREPARER | Direct payment from the plan; Consulting (general) Service code 16 | — | $24K |
| CROWE LLP EIN 35-0921680 FINANCIAL STATEMENT PREP | Direct payment from the plan; Consulting (general); Accounting (including auditing) Service code 10 | — | $20K |
| PRIME THERAPEUTICS LLC EIN 26-0076803 PHARMACY BENEFIT MANAGER | Contract Administrator; Direct payment from the plan; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication; Claims processing; Recordkeeping fees Service code 12 | — | $17K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 THIRD PARTY ADMINISTRATO | Other services; Participant communication; Claims processing; Direct payment from the plan; Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $6K |
| AON CONSULTING, INC. EIN 22-2232264 FORM 5500 PREPARER | Direct payment from the plan; Consulting (general) Service code 16 | — | $6K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 THIRD PARTY ADMINISTRATO | Other services; Float revenue 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 | 4,618 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,618 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HAWAII MEDICAL SERVICE ASSOCIATION | 0 | $7K |
| Life insurance(4 contracts) | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 1,517 | $512K |
| Prescription drug | HAWAII MEDICAL SERVICE ASSOCIATION | 0 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,517 | — |
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."
No prospect flags tripped on this filing.