| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ATLAS INSURANCE AGENCY, INC.3 | 201 MERCHANT STREET, SUITE 1100 HONOLULU, HI 96813 | HAWAII DENTAL SERVICE | $1K | — | $1K | 3.00% |
| ATLAS INSURANCE AGENCY, INC.3 | 201 MERCHANT STREET, SUITE 1100 HONOLULU, HI 96813 | USABLE LIFE | $2K | $485 | $2K | 18.89% |
| BECKI-LIN VICTORINE3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | $750 | $296 | $1K | 8.38% |
| JANE KIKAWA3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | — | $25 | $25 | 0.20% |
| ATLAS INSURANCE AGENCY, INC.3 | 201 MERCHANT STREET, SUITE 1100 HONOLULU, HI 96813 | USABLE LIFE | $1K | $436 | $2K | 13.88% |
| BECKI-LIN VICTORINE3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | $702 | $266 | $968 | 8.62% |
| JANE KIKAWA3 | PO BOX 860 HONOLULU, HI 96808 | USABLE LIFE | — | $22 | $22 | 0.20% |
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 | 145 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 145 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HMSA | 94 | $709K |
| Dental | HAWAII DENTAL SERVICE | 132 | $46K |
| Vision(2 contracts, 2 carriers) | HMSA | 94 | $709K |
| Life insurance | USABLE LIFE | 51 | $12K |
| Long-term disability | USABLE LIFE | 51 | $11K |
| Prescription drug(2 contracts, 2 carriers) | HMSA | 94 | $709K |
| Other(3 contracts, 2 carriers) | USABLE LIFE | 143 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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.