No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 36-2735957 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $858K |
| AETNA INC. EIN 06-6033492 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $147K |
| UMR, INC. EIN 39-1995276 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $47K |
| QUANTUM HEALTH, INC. EIN 20-8423895 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $36K |
| BDO USA, P.C. EIN 13-5381590 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $35K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $23K |
| JP MORGAN CHASE EIN 13-4994650 TRUSTEE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $8K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7,070 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 7,070 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF HAWAII | 2 | $18K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF HAWAII | 2 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.