| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | UNIVERSITY HEALTH ALLIANCE | $19K | — | $19K | 3.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 10505 SORRENTO VALLEY ROAD SUITE 200 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $11K | — | $11K | 2.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 10505 SORRENTO VALLEY ROAD SUITE 200 SAN DIEGO, CA 92121 | HAWAII DENTAL SERVICE | $2K | — | $2K | 2.00% |
| MJ INSURANCE3 Filed as: DUSTIN D. DENIZ AND VARIOUS AGENTS | 222 LILIUOKALANI AVENUE, SUITE 803 HONOLULU, HI 96815 | AFLAC | $7K | $412 | $7K | 9.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 10505 SORRENTO VALLEY ROAD SUITE 200 SAN DIEGO, CA 92121 | AFLAC | $7K | — | $7K | 8.43% |
| JACQUELYN E. K. HOLDER3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $4K | $159 | $4K | 5.29% |
| DERRICK K CHING3 Filed as: DERRICK K. CHING | PO BOX 833 KAPAA, HI 96746 | AFLAC | $3K | $21 | $3K | 3.23% |
| HEATHER SIEMS3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $2K | $32 | $2K | 2.29% |
| TYLER K PANG3 Filed as: TYLER K. PANG | 2510 RAINBOW DRIVE HONOLULU, HI 96822 | AFLAC | $1K | $27 | $1K | 1.74% |
| DEAN TAKASHI YONESHIGE3 | 1430 ALA HAHANUI STREET HONOLULU, HI 96818 | AFLAC | $1K | $41 | $1K | 1.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | 10505 SORRENTO VALLEY ROAD SAN DIEGO, CA 92121 | AFLAC | $4K | — | $4K | 8.26% |
| JACQUELYN E. K. HOLDER3 Filed as: JACQUELYN E K HOLDER | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $3K | $68 | $3K | 6.89% |
| MJ INSURANCE3 Filed as: KRISTIN H. MANNO AND VARIOUS AGENTS | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $2K | $15 | $3K | 5.72% |
| ARNOLD TARIN3 Filed as: ARNOLD U. TARIN | 1757 11TH STREET, SUITE 5 SANTA MONICA, CA 90404 | AFLAC | $2K | $54 | $2K | 4.11% |
| HEATHER SIEMS3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $2K | $25 | $2K | 3.81% |
| CHARLES N. CRAVINGS JR3 Filed as: CHARLES N. CRAVINGS JR. | 1467 WEST 49TH STREET LOS ANGELES, CA 90062 | AFLAC | $1K | $2 | $1K | 2.90% |
| JD HOLDER ENTERPRISES INC3 Filed as: JD HOLDER ENTERPRISES, INC. | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $992 | $10 | $1K | 2.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 10505 SORRENTO VALLEY ROAD SUITE 200 SAN DIEGO, CA 92121 | AFLAC | $162 | — | $162 | 2.92% |
| JACQUELYN E. K. HOLDER3 Filed as: JACQUELYN E.K. HOLDER | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $100 | $24 | $124 | 2.24% |
| STEPHEN C JONES3 Filed as: STEPHEN C. JONES | PO BOX 17284 MISSOULA, MT 59808 | AFLAC | $41 | $35 | $76 | 1.37% |
| CHRISTOPHER KANE3 | 3641 EAST KLATT ROAD ANCHORAGE, AK 99516 | AFLAC | $68 | — | $68 | 1.23% |
| TREVOR G NORENBERG3 Filed as: TREVOR G. NORENBERG | 10000 NORTH 31ST AVENUE PHOENIX, AZ 85051 | AFLAC | $50 | $7 | $57 | 1.03% |
| GARY L. FERRENBURG3 | 1809 WEST 104TH AVENUE ANCHORAGE, AK 99515 | AFLAC | $10 | $7 | $17 | 0.31% |
| TREVOR G NORENBERG3 Filed as: TREVOR G. NORENBERG | 11225 NORTH 28TH DRIVE, SUITE C216 PHOENIX, AZ 85029 | AFLAC | $16 | — | $16 | 0.29% |
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 | 196 | 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) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 182 | $1.2M |
| Dental | HAWAII DENTAL SERVICE | 371 | $101K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 182 | $1.2M |
| Life insurance(3 contracts) | AFLAC | 129 | $128K |
| Short-term disability(3 contracts) | AFLAC | 129 | $128K |
| Prescription drug(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 182 | $1.2M |
| Other(3 contracts) | AFLAC | 129 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 371 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.