| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFITS ADVISORS | FAINA GITMAN STE 635 21300 VICTORY BLVD WOODLAND HILLS, CA 91367 | MINNESOTA LIFE INSURANCE COMPANY | — | $240K | $240K | 2.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 06-0303370 NONE | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication; Float revenue Service code 12 | — | $3.1M |
| UNITED HEALTH CARE EIN 36-2739571 NONE | Participant communication; Claims processing; Direct payment from the plan Service code 12 | — | $1.1M |
| CIGNA BEHAVIORAL HEALTH INC. EIN 41-1648670 NONE | Participant communication; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $491K |
| CAREMARK EIN 95-3382344 NONE | Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | — | $381K |
| CONSUMERS MEDICAL RESOURCE, INC. EIN 04-3367006 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $270K |
| WAGEWORKS EIN 94-3351864 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $87K |
| CONEXIS EIN 20-0198855 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $59K |
| TRUVERIS, INC. EIN 27-4345686 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $48K |
| CROWE HORWATH LLP EIN 35-0921680 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $47K |
| ENNIS KNUPP EIN 36-3109431 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $40K |
| MELLON BANK EIN 25-0659306 NONE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $9K |
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 | 13,875 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 380 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 14,255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 110 | $16K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 3,054 | $1.1M |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 25,175 | $1.7M |
| Life insurance | MINNESOTA LIFE INSURANCE COMPANY | 20,447 | $10.5M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 14,255 | $5.1M |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 3,054 | $1.1M |
| Other(3 contracts, 3 carriers) | MINNESOTA LIFE INSURANCE COMPANY | 20,447 | $11.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 25,175 | — |
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.