| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVE NE STE 200 BELLEVUE, WA 98004 | SYMETRA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.33% |
| CONNEXION INSURANCE SOLUTIONS3 | 7001 220TH ST SW MS320 MOUNTLAKE TERRAC, WA 98043 | SYMETRA LIFE INSURANCE COMPANY | $753 | — | $753 | 5.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER & CO | 2850 GOLF RD 5TH FLR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | — | $173 | $173 | 1.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 606945287 | VISION SERVICE PLAN | $846 | — | $846 | 10.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $94K |
| MOSS ADAMS LLP EIN 91-0189318 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $39K |
| TOWERS WATSON INVESTMENT SVCS, INC. EIN 52-1868818 NONE | Investment management; Direct payment from the plan Service code 28 | — | $26K |
| MATRIX TRUST COMPANY EIN 75-3182674 CORPORATE TRUSTEE | Investment management fees paid indirectly by plan; Direct payment from the plan; Trustee (bank, trust company, or similar financial institution); Float revenue Service code 21 | — | $12K |
| BANK OF NEW YORK MELLON EIN 13-5160382 TRUSTEE | Shareholder servicing fees; Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $9K |
| UBS FINANCIAL SERVICES, INC. EIN 13-2638166 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $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 | 230 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 140 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 370 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICES ASSOCIATION | 109 | $576K |
| Vision | VISION SERVICE PLAN | 64 | $8K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 140 | $15K |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICES ASSOCIATION | 109 | $576K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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.