No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SUFFOLK ADMINISTRATIVE SERVICES, LL EIN 66-0833161 3RD PARTY SVC PROVIDER | Other services; Consulting (general) Service code 16 | — | $11K |
| HAWAII MAINLAND ADMINISTRATORS, LLC EIN 45-4411599 3RD PARTY SVC PROVIDER | Claims processing; Other services; Trustee (bank, trust company, or similar financial institution) Service code 12 | 1600 W BROADWAY ROAD STE 300 TEMPE, AZ 85282 | $7K |
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 | 32 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 32 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Other | PROVIDENCE INSURANCE COMPANY II | 32 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 32 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.