| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC4 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | MINNESOTA LIFE INSURANCE COMPANY | $89K | $50K | $139K | 6.28% |
| WILLIS TOWERS WATSON US LLC4 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | MINNESOTA LIFE INSURANCE COMPANY | $68K | $39K | $107K | 6.28% |
| WILLIS TOWERS WATSON US LLC4 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | RELIANCE STANDARD LIFE INSURANCE COMPNAY | $0 | $4K | $4K | 0.26% |
| WILLIS TOWERS WATSON US LLC4 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | MINNESOTA LIFE INSURANCE COMPANY | $14K | $8K | $22K | 6.28% |
| WILLIS TOWERS WATSON US LLC4 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $863 | $863 | 1.00% |
| WILLIS TOWERS WATSON US LLC4 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $27 | $27 | 1.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA EIN 91-0499247 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $3.7M |
| AETNA EIN 06-6033492 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $2.5M |
| HEWITT ASSOCIATES EIN 36-2235791 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.2M |
| DELTA DENTAL EIN 91-0621480 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $559K |
| EXPRESS SCRIPTS EIN 22-3461740 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $535K |
| VISION SERVICE PLAN EIN 22-2586639 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $153K |
| MOSS ADAMS LLP EIN 91-0189318 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $39K |
| WELLS FARGO EIN 94-1347393 NONE | Other fees; Trustee (bank, trust company, or similar financial institution); Distribution (12b-1) fees; Shareholder servicing fees Service code 21 | — | $10K |
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 | 10,110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 228 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 118 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 10,456 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HMSA - BCBS OF HAWAII | 288 | $1.8M |
| Life insurance(3 contracts) | MINNESOTA LIFE INSURANCE COMPANY | 10,756 | $4.3M |
| Short-term disability(3 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 167 | $99K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPNAY | 10,103 | $1.5M |
| Other(3 contracts, 2 carriers) | MINNESOTA LIFE INSURANCE COMPANY | 10,726 | $2.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,756 | — |
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.