| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | ENTERPRISE LICENSING CENTER 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 0.22% |
| USI INSURANCE SERVICES LLC3 | 101 WEST MAIN STREET SUITE 900 NORFOLK, VA 23510 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $24K | $28K | $53K | 10.79% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE SUITE 400 VALHALLA, NY 10595 | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 4.92% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE SUITE 400 VALHALLA, NY 10595 | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | $64 | — | $64 | 2.11% |
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 | 3,876 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 24 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,900 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 57 | $213K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,570 | $263K |
| Vision(2 contracts) | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | 6,528 | $234K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 5,829 | $834K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 2,879 | $490K |
| Other(2 contracts) | ARCH INSURANCE COMPANY | 7,234 | $170K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,234 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.