| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | 101 SOUTH HANLEY ROAD STE 900 SAINT LOUIS, MO 63105 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | $656K | $28K | $684K | 5.36% |
| DISABILITY MGMT ALT, LLC3 | 9 FARM SPRING ROAD 1ST FLOOR FARMINGTON, CT 06032 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $307K | $307K | 3.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | LOCKBOX 28852 NEW YORK, NY 10087 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $19K | $19K | 0.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | LOCKBOX 28852 NEW YORK, NY 10087 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS INSURANCE CO. EIN 95-4331852 N/A | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $6.1M |
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 N/A | Claims processing; Other services Service code 12 | — | $5.5M |
| HEALTH FITNESS CORPORATION EIN 41-1580506 N/A | Other services; Other fees Service code 49 | — | $1.3M |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 N/A | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $1.2M |
| CONNECTYOURCARE, LLC EIN 26-1274092 N/A | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $810K |
| COMPSYCH EIN 36-3739783 N/A | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $777K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 N/A | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $596K |
| AON HEWITT ABSENCE MANAGEMENT, LLC EIN 22-2232264 N/A | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $433K |
| TRI-STAR BENEFIT SYSTEMS, INC. EIN 43-1458791 N/A | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $107K |
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 | 31,989 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 470 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 32,459 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HAWAII MEDICAL SERVICE ASSOCIATION | 185 | $697K |
| Vision | VISION SERVICE PLAN INSURANCE COMPANY | 15,931 | $2.8M |
| Life insurance(2 contracts) | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 32,288 | $16.3M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 28,843 | $9.4M |
| Prescription drug | HAWAII MEDICAL SERVICE ASSOCIATION | 185 | $697K |
| Other(2 contracts) | ZURICH AMERICAN INSURANCE COMPANY | 31,967 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 32,288 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.