| 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 | $8K | $626 | $9K | 0.42% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1120 SANCTUARY PARKWAY, SUITE 300 AJARETTA, GA 30009 | SYMETRA LIFE INSURANCE COMPANY | — | $43K | $43K | 4.49% |
| PREMERA BLUE CROSS3 | PO BOX 34315 SEATTLE, WA 98124 | FOUR EVER LIFE INS CO. | — | $4K | $4K | 4.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | MONUMENTAL LIFE INSURANCE COMPANY | $2K | — | $2K | 5.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BS BC OF ALASKA CORP. EIN 48-1298079 CONTRACT ADMINISTRATOR | Non-monetary compensation; Contract Administrator; Float revenue; Claims processing; Named fiduciary; Direct payment from the plan; Participant communication; Other services Service code 12 | — | $657K |
| CIGNA HEALTH AND LIFE INS. COMPANY EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $543K |
| ALLIANT EIN 33-0785439 BROKER | Insurance agents and brokers Service code 22 | — | $175K |
| LIFE INS. COMPANY OF NORTH AMERICA EIN 23-1503749 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $102K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $73K |
| 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 | $38K |
| VISION SERVICE PLAN EIN 92-0078509 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $37K |
| VIVACITY EIN 26-4402130 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $31K |
| BENEFIT COORDINATORS CORPORATION EIN 25-1453488 CONTRACT ADMINISTRATORS | Contract Administrator Service code 13 | — | $22K |
| THE ULTIMATE SOFTWARE GROUP, INC. EIN 65-0694077 1095 PRINTING SERVICES | Other services Service code 49 | — | $14K |
| WELLS FARGO BANK, N.A. PLAN TRUSTEE | Account maintenance fees; Trustee (bank, trust company, or similar financial institution) Service code 21 | 601 UNION STREET SEATTLE, WA 98101 | $11K |
| MERCER HEALTH AND BENEFITS, LLC NONDISCRIMINATION TESTING | Consulting fees Service code 70 | 17901 VON KARMEN AVENUE, SUITE 1100 IRVINE, CA 92614 | $7K |
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 | 2,942 | 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) | 2,942 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 61 | $262K |
| Dental(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 26 | $221K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 26 | $221K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,885 | $2.2M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,885 | $2.1M |
| Prescription drug(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 61 | $262K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 1,049 | $1.5M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,000 | $2.2M |
| 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.