| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $50K | $50K | 1.91% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1120 SANCTUARY PARKWAY, SUITE 300 ALPHARETTA, GA 30009 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $13K | $13K | 0.48% |
| BENEFIT ADVISORS SERVICES GROUP LLC3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $32K | $32K | 6.00% |
| RINGMASTER INSURANCE AGENCY LLC3 | 5200 TOWN CENTER CIRCLE, SUITE 540 BOCA RATON, FL 33486 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $1K | $1K | 0.19% |
| ALLIANT INSURANCE SERVICES, INC.3 | 401 UNION STREET, 31ST FLOOR SEATTLE, WA 98101 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $18K | $0 | $18K | 7.33% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | HARTFORD ACCIDENT AND LIFE INSURANCE COMPANY | $3K | $0 | $3K | 5.16% |
| ALLIANT INSURANCE SERVICES, INC.3 | 450 COUNTRY CLUB ROAD, SUITE 340 EUGENE, OR 97401 | USABLE LIFE | $269 | $0 | $269 | 3.11% |
| JODI-LYNN SMITH3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | $115 | $0 | $115 | 1.33% |
| ALLIANT INSURANCE SERVICES, INC.3 | 401 UNION STREET, SUITE 3100 SEATTLE, WA 98101 | SHELTERPOINT LIFE INSURANCE COMPANY | $682 | $0 | $682 | 13.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BCBS OF ALASKA CORP EIN 48-1298079 CONTRACT ADMINISTRATOR | Non-monetary compensation; Claims processing; Contract Administrator; Named fiduciary; Float revenue; Participant communication; Other services; Direct payment from the plan Service code 12 | — | $970K |
| ALLIANT EIN 33-0785439 BROKER | Insurance agents and brokers Service code 22 | — | $175K |
| AETNA EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $115K |
| EVERNORTH CARE SOLUTIONS, INC EIN 86-1465626 CONTRACT ADMINISTRATOR | Participant communication; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $75K |
| PERSONIFY HEALTH EIN 20-2547480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $48K |
| HSABANK CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 939 SHEBOYGAN, WI 53082 | $43K |
| BDO USA, P.C. EIN 13-5381590 AUDITOR | Accounting (including auditing) Service code 10 | — | $32K |
| VISION SERVICE PLAN EIN 20-2547480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $24K |
| UKG, INC. EIN 65-0694077 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $11K |
| PRINCIPAL CUSTODY SOLUTIONS TRUSTEE | Account maintenance fees; Trustee (bank, trust company, or similar financial institution) Service code 21 | 711 HIGH STREET DES MOINES, IA 50392 | $9K |
| MERCER AUDITOR | Accounting (including auditing) Service code 10 | 17901 VON KARMAN AVENUE, SUITE 1100 IRVINE, CA 92614 | $9K |
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 | 3,164 | 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) | 3,164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | FOUR EVER LIFE INSURANCE COMPANY | 127 | $466K |
| Dental(2 contracts, 2 carriers) | FOUR EVER LIFE INSURANCE COMPANY | 26 | $416K |
| Vision(2 contracts, 2 carriers) | FOUR EVER LIFE INSURANCE COMPANY | 26 | $416K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,164 | $2.8M |
| Short-term disability(2 contracts, 2 carriers) | USABLE LIFE | 35 | $14K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,164 | $2.6M |
| Prescription drug(3 contracts, 3 carriers) | FOUR EVER LIFE INSURANCE COMPANY | 127 | $466K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 1,433 | $533K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,164 | $2.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,164 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.