| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER REPPOND A DIVISION | OF GALLAGHER BENEFIT SERVICES 2850 GOLF RD, STE. 1000 ROLLING MEADOWS, IL 600084036 | VISION SERVICE PLAN | $700 | — | $700 | 4.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER & CO | 2850 GOLF RD 5TH FLR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | $854 | $115 | $969 | 6.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UBS FINANCIAL SERVICES, INC. EIN 13-2638166 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $34K |
| MOSS ADAMS EIN 91-0189318 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $15K |
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $11K |
| SCHWAB RETIREMENT PLAN SERVICES INC EIN 34-1479833 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Shareholder servicing fees Service code 15 | — | $2K |
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 | 224 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 152 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 376 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICES ASSOCIATION | 99 | $486K |
| Vision | VISION SERVICE PLAN | 66 | $15K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 128 | $14K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 128 | $14K |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICES ASSOCIATION | 99 | $486K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 128 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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.