| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD STE 100 AGOURA HILLS, CA 91301 | KAISER FOUNDATION HEALTH PLAN INC. | $33K | — | $33K | 0.73% |
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY | 1132 BISHOP STREET SUITE 1600 HONOLULU, HI 96814 | UNIVERSITY HEALTH ALLIANCE | $83K | — | $83K | 3.02% |
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY INC. | 1132 BISHOP ST #1600 HONOLULU, HI 96813 | KAISER FOUNDATION OF HEALTH PLAN OF HAWAII | $24K | — | $24K | 3.34% |
| AFFINITY GROUP BENEFITS LLC3 | STE 200 2850 W HORIZON RIDGE PARKWAY HENDERSON, NV 89052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 3.06% |
| KARR, TINA L3 | 24448 VALENCIA BLVD STE 4203 VALENCIA, CA 91355 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 3.05% |
| GRIFFIN, STEVEN, RAY3 Filed as: GRIFFIN, STEVEN R | STE 1400 2000 MORRIS AVE BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $1K | $6K | 3.73% |
| AFFINITY GROUP BENEFITS LLC3 | STE 1400 2850 W HORIZON RIDGE PARKWAY HENDERSON, NV 89052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.52% |
| KARR, TINA L3 | 24448 VALENCIA BLVD STE 4203 VALENCIA, CA 91355 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.52% |
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY | 201 MERCHANT ST SUITE 1100 HONOLULU, HI 96813 | VISION SERVICE PLAN | $4K | — | $4K | 9.27% |
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 | 1,538 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,552 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,005 | $8.0M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 802 | $815K |
| Vision(3 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 877 | $2.9M |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 451 | $453K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 451 | $297K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,005 | $8.0M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 451 | $453K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,005 | — |
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.