| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | HAWAII DENTAL SERVICE | $9K | $0 | $9K | 1.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $2K | $0 | $2K | 0.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | SYMETRA LIFE INSURANCE COMPANY | $84K | $0 | $84K | 20.76% |
| CONNEXION INSURANCE SOLUTIONS3 | 7001 220TH STREET SW MS320 MOUNTLAKE TERRACE, WA 98043 | SYMETRA LIFE INSURANCE COMPANY | $16K | $0 | $16K | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 1.13% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $27 | $1K | 6.24% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET, SUITE 1400 HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $626 | $0 | $626 | 2.81% |
| ANDREA MARIE TIERCE3 Filed as: ANDREA MARIE TEIRCE | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $119 | $58 | $177 | 0.80% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 29840 NETWORK PLACE CHICAGO, IL 60673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $165 | $0 | $165 | 0.74% |
| BELLA NATION BENEFITS LLC3 Filed as: BELLA NATION BENEFITS, LLC | 8693 TARA HILL AVENUE LAS VEGAS, NV 89148 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $0 | $63 | 0.28% |
| CHRISTINA D POLK INC3 Filed as: CHRISTINA POLK | 9755 QUENCIA COURT LAS VEGAS, NV 89149 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 0.11% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INS. ADV. & OTHER AGENTS | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $3 | $22 | 0.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 23.27% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET, SUITE 1400 HONOLULU, HI 96813 | UNUM LIFE INSURANCE COMPANY OF AMERICA | -$2K | $0 | -$2K | -8.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $924 | $0 | $924 | 5.08% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $513 | $4 | $517 | 4.69% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET, SUITE 1400 HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $217 | $0 | $217 | 1.97% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 29840 NETWORK PLACE CHICAGO, IL 60673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $46 | $0 | $46 | 0.42% |
| BELLA NATION BENEFITS LLC3 Filed as: BELLA NATION BENEFITS, LLC | 8693 TARA HILL AVENUE LAS VEGAS, NV 89148 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $44 | $0 | $44 | 0.40% |
| ANDREA MARIE TIERCE3 Filed as: ANDREA MARIE TEIRCE | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $29 | $5 | $34 | 0.31% |
| CHRISTINA D POLK INC3 Filed as: CHRISTINA D. POLK, INC. | 9755 QUENCIA COURT LAS VEGAS, NV 89149 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.08% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.04% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES INC. | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $140 | $8 | $148 | 7.93% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET, SUITE 1400 HONOLULU, HI 96813 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $140 | $0 | $140 | 7.50% |
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 | 364 | 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) | 371 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 735 | $5.1M |
| Dental | HAWAII DENTAL SERVICE | 853 | $690K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 735 | $4.4M |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 360 | $406K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 360 | $406K |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 735 | $5.1M |
| Other(7 contracts, 5 carriers) | SYMETRA LIFE INSURANCE COMPANY | 375 | $470K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 853 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.