| 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 | $7K | $28K | $35K | 1.96% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $45K | $45K | 4.52% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $44K | $44K | 4.47% |
| PREMERA BLUE CROSS3 | PO BOX 327 SEATTLE, WA 98111 | FOUR EVER LIFE INS. CO. | $5K | $0 | $5K | 4.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | MONUMENTAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 4.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BC BS OF ALASKA CORP. EIN 48-1298079 CONTRACT ADMINISTRATOR | Other services; Named fiduciary; Direct payment from the plan; Contract Administrator; Claims processing; Non-monetary compensation; Float revenue; Participant communication Service code 12 | — | $621K |
| ALLIANT EIN 33-0785439 BROKER | Insurance agents and brokers Service code 22 | — | $175K |
| LIFE INS. COMPANY OF NORTH AMERICA EIN 23-1503749 CONTACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $96K |
| MILLENNIUM EIN 23-2981141 INSURANCE SERVICES | Insurance services Service code 23 | — | $82K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $75K |
| PHOENIX ADMIN DBA PERF HEALTH EIN 47-4998645 CLAIMS PROCESSING | Claims processing Service code 12 | — | $69K |
| KPMG EIN 13-5565207 AUDITING | Accounting (including auditing) Service code 10 | — | $57K |
| S AND S HEALTHCARE EIN 31-1418743 INSURANCE BROKER | Insurance agents and brokers Service code 22 | — | $41K |
| VIVACITY EIN 26-4402130 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $38K |
| HSA BANK CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 939 SHEBOYGAN, WI 53082 | $36K |
| VISION SERIVCE PLAN EIN 92-0078509 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $36K |
| BENEFIT COORDINATORS CORPORATION EIN 25-1453488 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $29K |
| BMI AUDIT SERVICES, LLC EIN 35-2051914 AUDITING | Accounting (including auditing) Service code 10 | — | $17K |
| THE ULTIMATE SOFTWARE GROUP, INC. EIN 65-0694077 PRINTING SERVICES | Other services Service code 49 | — | $14K |
| WELLS FARGO BANK, N.A. EIN 94-1347393 PLAN TRUSTEE | Account maintenance fees; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $11K |
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 | 2,945 | 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) | 2,945 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 44 | $172K |
| Dental(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 23 | $277K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $1.9M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $1.8M |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 44 | $172K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,945 | $1.3M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $1.8M |
| 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."
No prospect flags tripped on this filing.