| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | UNIVERSITY HEALTH ALLIANCE | $23K | — | $23K | 2.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 10505 SORRENTO VALLEY ROAD SUITE 200 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $12K | — | $12K | 1.97% |
| 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: HEATHER SIEMS AND VARIOUS AGENTS | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $7K | $945 | $8K | 8.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $6K | — | $6K | 6.62% |
| JACQUELYN E. K. HOLDER3 Filed as: JACQUELYN HOLDER | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $4K | $468 | $4K | 4.82% |
| JACK HOLDER3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $2K | $94 | $2K | 2.30% |
| GEORGE R. FONTAINE3 Filed as: GEORGE FONTAINE | 3157 WAAKEA PLACE KIHEI, HI 96753 | AFLAC | $1K | — | $1K | 1.44% |
| RUSSELL A. HAYASHI3 Filed as: RUSSELL HAYASHI | PO BOX 20 PEPEEKEO, HI 96783 | AFLAC | $1K | $71 | $1K | 1.40% |
| TYLER K PANG3 Filed as: TYLER PANG | 2510 RAINBOW DRIVE HONOLULU, HI 96822 | AFLAC | $1K | $60 | $1K | 1.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $3K | — | $3K | 6.29% |
| MJ INSURANCE3 Filed as: BRIAN R. MILLER AND VARIOUS AGENTS | 810 VIA ESTRELLITA AVENUE GLENDORA, CA 91741 | AFLAC | $2K | $471 | $2K | 5.18% |
| JACQUELYN E. K. HOLDER3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $2K | $327 | $2K | 4.83% |
| JD HOLDER ENTERPRISES INC3 Filed as: JD HOLDER ENTERPRISES, INC. | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $1K | $94 | $1K | 3.06% |
| ANA ROSA VANARETTE3 | 2554 NORTH BEECHWOOD AVENUE RIALTO, CA 92377 | AFLAC | $930 | — | $930 | 2.00% |
| HEATHER SIEMS3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $733 | $94 | $827 | 1.77% |
| GREGORY JOHN JUBINAL3 | 5798 RANCHO HILLS DRIVE SAN DIEGO, CA 92139 | AFLAC | $737 | — | $737 | 1.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $288 | — | $288 | 5.84% |
| JACQUELYN E. K. HOLDER3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $187 | — | $187 | 3.79% |
| SHAUNNA FERRENBURG3 | 1809 WEST 104TH AVENUE ANCHORAGE, AK 99515 | AFLAC | $116 | — | $116 | 2.35% |
| CHRISTOPHER KANE3 | 3641 EAST KLATT ROAD ANCHORAGE, AK 99516 | AFLAC | $92 | — | $92 | 1.86% |
| MARIA THOMAS SOWA3 | 7810 MAE RENE CIRCLE ANCHORAGE, AK 99502 | AFLAC | $85 | — | $85 | 1.72% |
| TREVOR G NORENBERG3 Filed as: TREVOR NORENBERG AND OTHER AGENTS | 6529 SAHALEE COURT RAPID CITY, SD 57702 | AFLAC | $55 | — | $55 | 1.11% |
| GARY L. FERRENBURG3 | 1809 WEST 104TH AVENUE ANCHORAGE, AK 99515 | AFLAC | $29 | — | $29 | 0.59% |
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 | 213 | 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) | 213 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 186 | $1.4M |
| Dental | HAWAII DENTAL SERVICE | 217 | $101K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 186 | $1.4M |
| Life insurance(3 contracts) | AFLAC | 123 | $143K |
| Short-term disability(3 contracts) | AFLAC | 123 | $143K |
| Prescription drug(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 186 | $1.4M |
| Other(3 contracts) | AFLAC | 123 | $143K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 217 | — |
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.