| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | AETNA LIFE INSURANCE COMPANY | $43K | $2K | $45K | 5.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | AETNA HEALTH, INC. | $37K | — | $37K | 5.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | AETNA LIFE INSURANCE COMPANY | $11K | — | $11K | 4.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | AETNA HEALTH, INC. | $9K | — | $9K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | DELTA DENTAL OF CALIFORNIA | $7K | — | $7K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $2K | — | $2K | 1.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | STANDARD INSURANCE COMPANY | $4K | $262 | $4K | 17.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | STANDARD INSURANCE COMPANY | $3K | $217 | $3K | 14.13% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 13.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | VISION SERVICE PLAN | $2K | — | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $299 | — | $299 | 1.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 10.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. | $1K | — | $1K | 14.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | DELTA DENTAL OF CALIFORNIA | $703 | — | $703 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | VISION SERVICE PLAN | $496 | — | $496 | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | STANDARD INSURANCE COMPANY | $401 | $25 | $426 | 13.69% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J. GALLAGHER & CO. | 4100 NEWPORT PLACE, SUITE 650 NEWPORT BEACH, CA 92660 | STANDARD INSURANCE COMPANY | $265 | — | $265 | 10.33% |
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 | 195 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(8 contracts, 4 carriers) | AETNA LIFE INSURANCE COMPANY | 179 | $2.3M |
| Dental(4 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION - HMSA | 123 | $488K |
| Vision(2 contracts) | VISION SERVICE PLAN | 133 | $23K |
| Life insurance(2 contracts) | STANDARD INSURANCE COMPANY | 186 | $36K |
| Short-term disability(3 contracts, 2 carriers) | PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. | 35 | $14K |
| Long-term disability(2 contracts) | STANDARD INSURANCE COMPANY | 186 | $45K |
| Prescription drug(8 contracts, 4 carriers) | AETNA LIFE INSURANCE COMPANY | 179 | $2.3M |
| Other(2 contracts) | STANDARD INSURANCE COMPANY | 186 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 186 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.