| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | 335 MADISON AVE FL 20 NEW YORK, NY 100174633 | RELIASTAR LIFE INSURANCE COMPANY | — | $157K | $157K | 6.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $31K | $9K | $39K | 3.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | COMMISSIONS LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $44K | $0 | $44K | 4.27% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 0.21% |
| BUSINESSOLVER.COM, INC.3 Filed as: BUSINESSOLVER INC | 1025 ASHWORTH RD STE 403 WEST DES MOINES, IA 50265 | RELIASTAR LIFE INSURANCE COMPANY | $114K | — | $114K | 17.70% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | 11910 ANDERSON MILL RD AUSTIN, TX 78726 | RELIASTAR LIFE INSURANCE COMPANY | $15K | — | $15K | 2.30% |
| BSC AGENCY LLC3 | 1025 ASHWORTH RD STE 403 WEST DES MOINES, IA 502653567 | RELIASTAR LIFE INSURANCE COMPANY | $6K | — | $6K | 0.93% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $16K | $5K | $20K | 3.23% |
| BSC AGENCY LLC3 | 1025 ASHWORTH STE 101 WEST DES MOINES, IA 50265 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $19K | — | $19K | 4.17% |
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 | 3,734 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,751 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 165 | $1.0M |
| Dental(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 852 | $1.2M |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 5,201 | $448K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,440 | $1.0M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,981 | $1.2M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 5,438 | $626K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 165 | $1.0M |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 3,352 | $2.6M |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,440 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,440 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.