| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT, LLC. | 201 SOUTH WARREN STREET SUITE 100 SYRACUSE, NY 13202 | GUARDIAN | $76K | $13K | $89K | 9.89% |
| ALLIANCE ADVISORY GRP INC3 | 350 ESSJAY ROAD WILLIAMSVILLE, NY 14221 | GUARDIAN | -$1K | — | -$1K | -0.13% |
| KISTLER TIFFANY BENEFITS3 | 400 BERWYN PARK BERWYN, PA 19312 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $9K | — | $9K | 4.00% |
| KISTLER TIFFANY BENEFITS3 | 400 BERWYN PARK BERWYN, PA 19312 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 4.00% |
| ASSUREDPARTNERS3 Filed as: MORRIS & GARRITANO INSURANCE AGENCY | PO BOX 1189 SAN LUIS OBISPO, CA 93406 | LIBERTY DENTAL OF CALIFORNIA, INC. | $8 | — | $8 | 8.16% |
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 | 19,946 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 19,953 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF HAWAII | 45 | $350K |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF HAWAII | 45 | $26K |
| Vision | INDEPENDENCE BLUE CROSS AND AFFILIATES | 7 | $249 |
| Life insurance | GUARDIAN | 19,040 | $902K |
| Short-term disability | GUARDIAN | 19,040 | $902K |
| Long-term disability(3 contracts, 2 carriers) | GUARDIAN | 19,040 | $1.2M |
| Other | GUARDIAN | 19,040 | $902K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 19,040 | — |
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.