| 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 | — | $51K | $51K | 2.23% |
| PREMERA BLUE CROSS0 | PO BOX 327 SEATTLE, WA 98111 | FOUR EVER LIFE INSURANCE COMPANY | — | $720 | $720 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BC BS OF ALASKA CORP. EIN 48-1298079 CONTRACT ADMINISTRATOR | Other services; Float revenue; Contract Administrator; Named fiduciary; Non-monetary compensation; Claims processing; Participant communication; Direct payment from the plan Service code 12 | — | $694K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $84K |
| BENEFIT COORDINATORS CORPORATION EIN 25-1453488 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $33K |
| VISION SERVICE PLAN EIN 92-0078509 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $32K |
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 | 3,000 | 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) | 3,000 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 24 | $144K |
| Dental(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 24 | $144K |
| Vision | HAWAII MEDICAL SERVICE ASSOCIATION | 24 | $126K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,991 | $2.3M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,991 | $2.3M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,991 | $2.3M |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 24 | $144K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,000 | — |
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.