| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | $60K | $75K | 2.92% |
| BENEFIT ADVISORS SERVICES GROUP LLC3 Filed as: BENEFIT ADVISORS SERVICES GP, LLC | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $24K | $24K | 6.01% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | HARTFORD ACCIDENT AND LIFE INSURANCE COMPANY | $4K | $0 | $4K | 5.76% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | USABLE LIFE | $439 | $0 | $439 | 2.46% |
| JODI-LYNN SMITH3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | $120 | $0 | $120 | 0.67% |
| TODD OHIRA3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | $0 | $115 | $115 | 0.65% |
| JANE KIKAWA3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | $0 | $49 | $49 | 0.28% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 1420 5TH AVENUE, SUITE 1500 SEATTLE, WA 98101 | SHELTERPOINT LIFE INSURANCE COMPANY | $150 | $0 | $150 | 3.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIANT EIN 33-0785439 BROKER | Insurance agents and brokers Service code 22 | — | $175K |
| PREMERA BCBS OF ALASKA CORP EIN 48-1298079 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing; Other services; Participant communication; Named fiduciary; Non-monetary compensation; Float revenue Service code 12 | — | $138K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $93K |
| VIRGIN PULSE EIN 20-2547480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $44K |
| HSABANK CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 939 SHEBOYGAN, WI 53082 | $42K |
| BDO USA LLP EIN 13-5381590 AUDITOR | Accounting (including auditing) Service code 10 | — | $25K |
| VISION SERVICE PLAN EIN 20-2547480 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $23K |
| ULTIMATE SOFTWARE EIN 65-0694077 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $9K |
| PRINCIPAL CUSTODY SOLUTIONS TRUSTEE | Trustee (bank, trust company, or similar financial institution); Account maintenance fees Service code 21 | 711 HIGH STREET DES MOINES, IA 50392 | $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 | 2,983 | 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) | 2,983 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 87 | $670K |
| Dental(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 58 | $608K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 58 | $608K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,983 | $3.0M |
| Short-term disability(2 contracts, 2 carriers) | USABLE LIFE | 74 | $22K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,983 | $2.6M |
| Prescription drug(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 87 | $670K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 1,248 | $403K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 7,760 | $2.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,760 | — |
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.