| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | SUITE 300 3635 RIVERSIDE PLAZA DR RIVERSIDE, CA 92506 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 24.03% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | — | $216 | $216 | 0.37% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $929K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $36K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $13K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN. | Plan Administrator Service code 14 | — | $2K |
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 | 1,126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HAWAII MEDICAL SERVICE ASSOCIATION | 14 | $96K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF ARIZONA | 915 | $1.1M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 713 | $278K |
| Life insurance(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 1,116 | $155K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,116 | $230K |
| Other(11 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,213 | $474K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,213 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.