| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPYREAN INSURANCE SERVICES, INC. Filed as: EMPYREAN BENEFIT SOLUTIONS INC | 3010 BRIARPARK DR STE 8000 HOUSTON, TX 770423706 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $32K | $32K | 3.26% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS TOWERS WATSON LLC | COMMISSION PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $12K | $12K | 1.18% |
| WILLIS TOWERS WATSON US LLC | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $75K | — | $75K | 12.39% |
| EMPYREAN INSURANCE SERVICES, INC. Filed as: EMPYREAN BENEFIT SOLUTIONS INC | 3010 BRIARPARK DR STE 8000 HOUSTON, TX 770423706 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $15K | $15K | 3.26% |
| WILLIS TOWERS WATSON US LLC | COMMISSION PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $6K | $6K | 1.22% |
| EMPYREAN INSURANCE SERVICES, INC.5 Filed as: EMPYREAN BENEFIT SOLUTIONS INC | 3010 BRIARPARK DR#8000 HOUSTON, TX 770423706 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $16K | $16K | 5.44% |
| WILLIS TOWERS WATSON US LLC3 | P.O. BOX 28852 NEW YORK, NY 100878852 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $7K | $7K | 2.29% |
| WILLIS TOWERS WATSON US LLC3 | P.O. BOX 28852 NEW YORK, NY 100878852 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $63 | $63 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 100878852 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $18K | — | $18K | 11.07% |
| EMPYREAN INSURANCE SERVICES, INC. Filed as: EMPYREAN BENEFIT SOLUTIONS INC | 3010 BRIARPARK DR STE 8000 HOUSTON, TX 770423706 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $4K | $4K | 3.24% |
| WILLIS TOWERS WATSON US LLC | COMMISSION PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $2K | $2K | 1.29% |
| WILLIS TOWERS WATSON US LLC | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | DELAWARE AMERICAN LIFE INSURANCE OF AMERICA | $885 | — | $885 | 10.00% |
| WILLIS TOWERS WATSON US LLC | COMMISSION PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $64 | $64 | 1.25% |
| USI INSURANCE SERVICES LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $39 | $39 | 1.68% |
| WILLIS TOWERS WATSON US LLC | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $0 | $7 | $7 | 4.29% |
No Schedule C service providers reported on this filing.
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 | 1,521 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 27 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,583 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 700 | $461K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 125 | $604K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,521 | $1.0M |
| Short-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 3 | $163 |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,521 | $479K |
| Prescription drug | HAWAII MEDICAL SERVICE ASSOCIATION | 18 | $161K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 1,325 | $2.3M |
| Other(9 contracts, 6 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,657 | $927K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,657 | — |
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.