| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | PO BOX 123042 DALLAS, TX 75312 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $51K | $51K | 0.76% |
| LOCKTON COMPANIES, LLC3 | 500 WEST MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | KAISER FOUNDATION HEALTH PLAN INC | $60K | $0 | $60K | 2.29% |
| BENEFIT HEALTH ADVISOR3 | 9605 SOUTH KINGSTON COURT, SUITE 15 ENGLEWOOD, CO 80112 | HAWAII MEDICAL ASSURANCE ASSOCIATION | $0 | $11K | $11K | 1.36% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | HAWAII MEDICAL ASSURANCE ASSOCIATION | $7K | $0 | $7K | 0.85% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 9605 SOUTH KINGSTON COURT SUITE 150 ENGLEWOOD, CO 80012 | HAWAII MEDICAL ASSURANCE ASSOCIATION | $6K | $0 | $6K | 0.77% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 443 | $3.4M |
| Dental | HAWAII MEDICAL ASSURANCE ASSOCIATION | 182 | $827K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL ASSURANCE ASSOCIATION | 3,960 | $1.3M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,761 | $6.8M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,761 | $6.8M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,761 | $6.8M |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 443 | $3.4M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,761 | $6.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,761 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.