| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYEE BENEFITS RESOURCE, INC.3 | 700 BISHOP STREET, SUITE 502 HONOLULU, HI 96813 | HMAA | $35K | — | $35K | 2.88% |
| EMPLYEE BENEFITS RESOURCE, INC. | 700 BISHOP STREET, SUITE 502 HONOLULU, HI 96813 | KAISER PERMANENTE | $11K | — | $11K | 3.51% |
| EMPLOYEE BENEFITS RESOURCE, INC.3 | 700 BISHOP STREET, SUITE 502 HONOLULU, HI 96813 | HAWAII DENTAL SERVICE | $2K | — | $2K | 2.00% |
| RICHARD KERSTEN3 | 458 AULIMA LOOP KAILUA, HI 96734 | THE HARTFORD | $5K | — | $5K | 12.60% |
| MARY M MATTOS3 Filed as: MARY MATTOS | 344 A HUALANI STREET KAILUA, HI 96734 | THE HARTFORD | $962 | — | $962 | 2.40% |
| RICHARD KERSTEN3 | 900 FORT STREET, SUITE 500 HONOLULU, HI 96813 | PACIFIC GUARDIAN LIFE | $1K | — | $1K | 12.00% |
| MARY M MATTOS3 Filed as: MARY MATTOS | 355 HUALANI STREET, APT A KAILUA, HI 96734 | PRUDENTIAL | $268 | — | $268 | 9.39% |
| RICHARD KERSTEN3 | 458 AULIMA LOOP KAILUA, HI 96734 | PRUDENTIAL | $268 | — | $268 | 9.39% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE, SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL | — | $15 | $15 | 0.53% |
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 | 298 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HMAA | 366 | $1.5M |
| Dental | HAWAII DENTAL SERVICE | 271 | $110K |
| Vision(2 contracts, 2 carriers) | HMAA | 366 | $1.5M |
| Life insurance(2 contracts, 2 carriers) | PACIFIC GUARDIAN LIFE | 99 | $11K |
| Long-term disability | THE HARTFORD | 118 | $40K |
| Prescription drug(2 contracts, 2 carriers) | HMAA | 366 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 366 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.