| 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 | $17K | $0 | $17K | 0.64% |
| BENEFIT ADVISORS SERVICES GROUP LLC3 Filed as: BENEFIT ADVISORS SERVICES GROUP | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $27K | $27K | 6.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | HARTFORD ACCIDENT AND LIFE INSURANCE COMPANY | $3K | $0 | $3K | 5.88% |
| ALLIANT INSURANCE SERVICES, INC.3 | 2030 FALLING WATERS ROAD, SUITE 290 KNOXVILLE, TN 37922 | USABLE LIFE | $448 | $0 | $448 | 4.62% |
| JODI-LYNN SMITH3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | $119 | $0 | $119 | 1.23% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | SHELTERPOINT LIFE INSURANCE COMPANY | $613 | $0 | $613 | 15.53% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREMERA BCBS OF ALASKA CORP EIN 48-1298079 CONTRACT ADMINISTRATOR | Other services; Named fiduciary; Float revenue; Claims processing; Participant communication; Contract Administrator; Direct payment from the plan; Non-monetary compensation Service code 12 | — | $198K |
| ALLIANT EIN 33-0785439 BROKER | Insurance agents and brokers Service code 22 | — | $175K |
| AETNA EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $95K |
| VIRGIN PULSE EIN 20-2547480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $44K |
| HSABANK CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 939 SHEBOYGAN, WI 53082 | $39K |
| BDO USA, P.C. EIN 13-5381590 AUDITOR | Accounting (including auditing) Service code 10 | — | $30K |
| VISION SERVICE PLAN EIN 20-2547480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $22K |
| 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 |
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 | 2,868 | 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) | 2,868 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | FOUR EVER LIFE INS CO. | 68 | $599K |
| Dental(2 contracts, 2 carriers) | FOUR EVER LIFE INS CO. | 30 | $541K |
| Vision(2 contracts, 2 carriers) | FOUR EVER LIFE INS CO. | 30 | $541K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,868 | $2.9M |
| Short-term disability(2 contracts, 2 carriers) | USABLE LIFE | 41 | $14K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,868 | $2.7M |
| Prescription drug(3 contracts, 3 carriers) | FOUR EVER LIFE INS CO. | 68 | $599K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 1,288 | $442K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 7,760 | $2.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,760 | — |
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.