| 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 | 1.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | SYMETRA LIFE INSURANCE COMPANY | $66K | $24K | $90K | 14.82% |
| CONNEXION INSURANCE SOLUTIONS3 | 7001 220TH STREET SW, SUITE 320 MOUNTLAKE TERRANCE, WA 98043 | SYMETRA LIFE INSURANCE COMPANY | $33K | $0 | $33K | 5.45% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $6 | $3K | 6.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $875 | $1 | $876 | 2.00% |
| SERVO INSURANCE SERVICES CORP.3 | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $352 | $0 | $352 | 0.80% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $239 | $0 | $239 | 0.55% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 29840 NETWORK PLACE CHICAGO, IL 60673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $151 | $0 | $151 | 0.34% |
| MEGAN ELIZABETH CASTO3 | 10340 CARNEY DRIVE SE OLYMPIA, WA 98501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $36 | $99 | 0.23% |
| MJ INSURANCE3 Filed as: ANDREA M. TIERCE AND VARIOUS AGENTS | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $44 | $0 | $44 | 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 | 15.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.39% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $429 | $0 | $429 | 4.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $202 | $0 | $202 | 2.24% |
| SERVO INSURANCE SERVICES CORP.3 | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $157 | $0 | $157 | 1.74% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $25 | $0 | $25 | 0.28% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.21% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 29840 NETWORK PLACE CHICAGO, IL 60673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.19% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $195 | $0 | $195 | 4.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $29 | $0 | $29 | 0.74% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.56% |
| SERVO INSURANCE SERVICES CORP.3 | 700 BISHOP STREET HONOLULU, HI 96813 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.43% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.05% |
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 | 356 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 24 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 380 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 458 | $5.8M |
| Dental | HAWAII DENTAL SERVICE | 670 | $781K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 458 | $5.1M |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 356 | $605K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 356 | $605K |
| Prescription drug(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 458 | $5.8M |
| Other(7 contracts, 5 carriers) | SYMETRA LIFE INSURANCE COMPANY | 356 | $699K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 670 | — |
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.