| 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 | $10K | $0 | $10K | 1.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | SYMETRA LIFE INSURANCE COMPANY | $52K | $0 | $52K | 10.00% |
| CONNEXION INSURANCE SOLUTIONS3 | 7001 220TH STREET SW, MS320 MOUNTLAKE TERRACE, WA 98043 | SYMETRA LIFE INSURANCE COMPANY | $31K | $0 | $31K | 5.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | $0 | $13K | $13K | 2.45% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $129 | $5K | 13.55% |
| CYNTHIA ANN WILLEY3 | 84-757 KIANA PLACE WAIANAE, HI 96792 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $585 | $0 | $585 | 1.67% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $429 | $53 | $482 | 1.37% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $423 | $0 | $423 | 1.20% |
| ANDREA MARIE TIERCE3 Filed as: ANDREA M. TIERCE AND OTHER AGENTS | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $137 | $18 | $155 | 0.44% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 29840 NETWORK PLACE CHICAGO, IL 60673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $151 | $0 | $151 | 0.43% |
| TAMMY VAN HOUTEN-THOMPSON3 | 8693 TARA HILL AVENUE LAS VEGAS, NV 89148 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $84 | $0 | $84 | 0.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 15.43% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.02% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $37 | $2K | 15.73% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $148 | $13 | $161 | 1.64% |
| JEANICE LYN GEYROZAGA3 | 1916 ULA STREET HONOLULU, HI 96819 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $64 | $0 | $64 | 0.65% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $53 | $0 | $53 | 0.54% |
| TAMMY VAN HOUTEN-THOMPSON3 | 8693 TARA HILL AVENUE LAS VEGAS, NV 89148 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.17% |
| ARNOLD HEMEI BADIO3 | 2700 SW 27TH AVENUE MIAMI, FL 33133 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.05% |
| CHRISTINA D POLK INC3 Filed as: CHRISTINA POLK INC AND OTHER AGENTS | 9755 QUENCIA COURT LAS VEGAS, NV 89149 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.04% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $412 | $1 | $413 | 5.37% |
| SERVCO INSURANCE SERVICES CORP3 Filed as: SERVCO INSURANCE SERVICES CORP. | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $170 | $0 | $170 | 2.21% |
| JOLIE ANN SAM3 | 91-1290 KANEONEO STREET KAPOLEI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $33 | $44 | 0.57% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 29840 NETWORK PLACE CHICAGO, IL 60673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $43 | $0 | $43 | 0.56% |
| TAMMY VAN HOUTEN-THOMPSON3 | 8693 TARA HILL AVENUE LAS VEGAS, NV 89148 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 0.42% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $28 | $0 | $28 | 0.36% |
| CHRISTINA D POLK INC3 Filed as: CHRISTINA POLK INC AND OTHER AGENTS | 9755 QUENCIA COURT LAS VEGAS, NV 89149 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $1 | $15 | 0.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $13 | $13 | — |
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 | 375 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 378 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 833 | $5.9M |
| Dental | HAWAII DENTAL SERVICE | 821 | $775K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 833 | $5.3M |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 480 | $519K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 480 | $519K |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 833 | $5.9M |
| Other(7 contracts, 5 carriers) | SYMETRA LIFE INSURANCE COMPANY | 480 | $605K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 833 | — |
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.