| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET 14TH FLOOR HONOLULU, HI 96813 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $2K | — | $2K | 0.46% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO EMPLOYEE BENEFITS CONSULTING | 700 FORT STREET MALL SUITE 1400 HONOLULU, HI 96813 | HAWAII DENTAL SERVICE | $5K | — | $5K | 1.18% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO EMPLOYEE BENEFITS CONSULTING | 700 BISHOP ST STE 1400 HONOLULU, HI 96813 | VISION SERVICE PLAN | $741 | — | $741 | 3.91% |
| RITA S. ORNELLAS3 Filed as: RITA S ORNELLAS | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $8 | $1K | 8.79% |
| SERVCO INSURANCE SERVICES CORP3 | 700 BISHOP STREET HONOLULU, HI 96814 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $697 | — | $697 | 4.12% |
| AON CONSULTING INC3 | PO BOX 201 HONOLULU, HI 96810 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $141 | — | $141 | 0.83% |
| BELLA NATION BENEFITS LLC3 | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | — | $137 | 0.81% |
| CHRISTINA D POLK INC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | — | $62 | 0.37% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LN ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $11 | $29 | 0.17% |
| CALIFORNIA INSURANCE ADVOCATES INC3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.02% |
| MIKE MCCORMICK3 | 29811 SANTA MARGARITA PKWY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| SERVCO INSURANCE SERVICES CORP3 | 700 BISHOP STREET SUITE 1400 HONOLULU, HI 96813 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.74% |
| RITA S. ORNELLAS3 Filed as: RITA S ORNELLAS | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $524 | $3 | $527 | 10.09% |
| SERVCO INSURANCE SERVICES CORP3 | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $232 | — | $232 | 4.44% |
| BELLA NATION BENEFITS LLC3 | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.90% |
| AON CONSULTING INC3 | 29840 NETWORK PLACE CHICAGO, IL 60673 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.75% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LN ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $7 | $19 | 0.36% |
| CHRISTINA D POLK INC3 | 9755 QUENCIA CT LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.33% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES, INC | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.06% |
| RITA S. ORNELLAS3 Filed as: RITA S ORNELLAS | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $467 | $2 | $469 | 9.49% |
| SERVCO INSURANCE SERVICES CORP3 | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $215 | — | $215 | 4.35% |
| BELLA NATION BENEFITS LLC3 | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | — | $52 | 1.05% |
| CHRISTINA D POLK INC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.38% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LN ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.04% |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 747 | $3.0M |
| Dental | HAWAII DENTAL SERVICE | 884 | $397K |
| Vision | VISION SERVICE PLAN | 76 | $19K |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 747 | $3.0M |
| Other(4 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 25 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 884 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.