| 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 | $39K | $52K | $90K | 3.26% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $72K | $72K | 9.00% |
| PREMERA BLUE CROSS0 | PO BOX 327 SEATTLE, WA 98111 | FOUR EVER LIFE INSURANCE COMPANY | $0 | $2K | $2K | 4.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | MONUMENTAL LIFE INSURANCE COMPANY | $885 | $0 | $885 | 4.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BC BS OF ALASKA CORP EIN 48-1298079 CONTRACT ADMINISTRATOR | Float revenue; Claims processing; Participant communication; Other services; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Contract Administrator Service code 12 | — | $553K |
| PHOENIX ADMIN/PERFORMANCE HEALTH EIN 47-4998645 CLAIMS PROCESSING | Claims processing Service code 12 | — | $233K |
| MILLENNIUM EIN 23-2981141 INSURANCE SERVICES | Insurance services Service code 23 | — | $214K |
| ALLIANT EIN 33-0785439 BROKER | Insurance agents and brokers Service code 22 | — | $175K |
| S AND S HEALTHCARE EIN 31-1418743 INSURANCE BROKER | Insurance agents and brokers Service code 22 | — | $104K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $66K |
| VIVACITY EIN 26-4402130 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $56K |
| KPMG EIN 13-5565207 AUDITING | Accounting (including auditing) Service code 10 | — | $54K |
| HSA BANK CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 939 SHEBOYGAN, WI 53082 | $36K |
| VISION SERVICE PLAN EIN 92-0078509 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $33K |
| BENEFIT COORDINATORS CORPORATION EIN 25-1453488 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $31K |
| THE ULTIMATE SOFTWARE GROUP, INC. EIN 65-0694077 1095 PRINTING SERVICES | Other services Service code 49 | — | $17K |
| WELLS FARGO BANK, N.A. EIN 94-1347393 PLAN TRUSTEE | Trustee (bank, trust company, or similar financial institution); Account maintenance fees Service code 21 | — | $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 | 2,774 | 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) | 2,774 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 3,000 | $208K |
| Dental(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 3,000 | $190K |
| Vision | HAWAII MEDICAL SERVICE ASSOCIATION | 24 | $149K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $2.8M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $2.8M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $2.8M |
| Prescription drug(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 3,000 | $208K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,000 | $1.2M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $2.8M |
| 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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.