| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | 4742 NORTH 24TH STREET PHOENIX, AZ 85016 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $27K | $0 | $27K | 6.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY, LLC | PO BOX 419814 BOSTON, AZ 85016 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $18K | $0 | $18K | 4.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $226 | $226 | 0.05% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $5K | $0 | $5K | 4.78% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY, LLC | 7202 EAST ROSEWOOD, SUITE 200 TUCSON, AZ 85710 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $76K | $0 | $76K | 99.86% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 SCOTTSDALE, AZ 85260 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $7K | $7K | 8.73% |
| UNKNOWN3 | UNKNOWN SCOTTSDALE, AZ 85260 | TELADOC HEALTH, INC. | $3K | $0 | $3K | 9.09% |
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 | 943 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 943 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HAWAII MEDICAL SERVICE ASSOCIATION | 15 | $218K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,183 | $76K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,360 | $104K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 943 | $446K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 943 | $446K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 943 | $446K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,025 | $483K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,360 | — |
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.