| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | PO BOX 387 EVERETT, WA 98206 | KAISER FOUNDATION HEALTH PLAN, INC. | $80K | $0 | $80K | 2.92% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 2828 COLBY AVENUE, SUITE 404 EVERETT, WA 98201 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | $0 | $3K | 0.10% |
| ERIC M SILVERMAN3 Filed as: ERIC M. SILVERMAN | 1423 MARTIN MEADOWS DRIVE FALLSTON, MD 21047 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $57K | $8K | $65K | 17.09% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 WEST STATE ROAD 434 LONGWOOD, FL 32750 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $31K | $7K | $37K | 9.78% |
| NATIONAL BENEFIT PARTNER WEST LLC3 Filed as: NATIONAL BENEFIT PARTNER WEST, LLC | 99 WOOD AVENUE SOUTH, SUITE 501 ISELIN, NJ 08830 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $8K | $8K | 2.00% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 WEST STATE ROAD, SUITE 434 LONGWOOD, FL 32750 | VISION SERVICE PLAN | $4K | $0 | $4K | 4.60% |
| PSG, INC.3 | PO BOX 387 EVERETT, WA 98206 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $0 | $11K | 13.36% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 WEST STATE ROAD, SUITE 434 LONGWOOD, FL 32750 | HAWAII DENTAL SERVICES | $1K | $0 | $1K | 1.87% |
| PSG, INC.3 | 2828 COLBY AVENUE, SUITE 404 EVERETT, WA 98201 | HAWAII DENTAL SERVICES | $419 | — | $419 | 0.63% |
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 | 1,192 | 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) | 1,192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 445 | $3.8M |
| Dental | HAWAII DENTAL SERVICES | 176 | $66K |
| Vision | VISION SERVICE PLAN | 997 | $94K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $81K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 479 | $463K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $81K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 445 | $2.8M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 479 | $463K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 997 | — |
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.