| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC (GA) | DB EB OPERATING ACCOUNT PO BOX 8299 PASADENA, CA 91109 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $111K | — | $111K | 2.97% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $20K | $20K | 1.61% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $15K | $15K | 1.63% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $11K | $11K | 1.66% |
| BENEFIT ADVISORS SERVICES GROUP LLC3 Filed as: BENEFIT ADVISORS SERVICES GRP, LLC | PO BOX 675236 DETROIT, MI 482675236 | HCC LIFE INSURANCE COMPANY | — | $23K | $23K | 6.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.69% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $1K | $1K | 1.77% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 1.65% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC. | 701 B. STREET 6TH FLOOR SAN DIEGO, CA 92101 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $1K | — | $1K | 3.19% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICE | PO BOX 8299 DB EB OPERATING ACCOUNT PASADENA, CA 91109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $16 | $16 | 0.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX. INC. EIN 33-0441200 PHARMACY BENEFIT MANAGEM | Float revenue; Other fees; Claims processing; Direct payment from the plan Service code 12 | — | $11.4M |
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 ADMINISTRATIVE AGREEMENT | Participant communication; Direct payment from the plan; Non-monetary compensation; Claims processing; Contract Administrator; Other services; Float revenue; Named fiduciary Service code 12 | — | $3.1M |
| CIGNA | Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $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 | 6,415 | 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) | 6,439 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 4 | $40K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 9,398 | $3.7M |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 4,505 | $282K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,415 | $1.9M |
| Short-term disability(4 contracts, 2 carriers) | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 6,767 | $213K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,416 | $910K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 4,797 | $383K |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,718 | $322K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,398 | — |
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.