| 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 | $26K | $0 | $26K | 1.86% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 10505 SORRENTO VALLEY ROAD SUITE 200 SAN DIEGO, CA 92121 | HAWAII DENTAL SERVICE | $2K | $0 | $2K | 1.98% |
| MJ INSURANCE3 Filed as: RUSSELL HAYASHI AND VARIOUS AGENTS | PO BOX 20 PEPEEKEO, HI 96783 | AFLAC | $4K | $238 | $5K | 5.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $4K | $0 | $4K | 4.01% |
| JACQUELYN E. K. HOLDER3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $2K | $103 | $2K | 2.41% |
| TYLER K PANG3 Filed as: TYLER K. PANG | 1108 20TH AVENUE HONOLULU, HI 96816 | AFLAC | $852 | $19 | $871 | 1.00% |
| JACK DANIEL HOLDER3 | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $809 | $0 | $809 | 0.93% |
| SIEMS INSURANCE SOLUTIONS INC3 Filed as: SIEMS INSURANCE SOLUTIONS, INC. | 8220 UNIVERSITY AVENUE, SUITE 200 LA MESA, CA 91942 | AFLAC | $680 | $0 | $680 | 0.78% |
| DERRICK K CHING3 Filed as: DERRICK K. CHING | PO BOX 833 KAPAA, HI 96746 | AFLAC | $627 | $0 | $627 | 0.72% |
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 | 285 | 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) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 285 | $1.4M |
| Dental | HAWAII DENTAL SERVICE | 204 | $93K |
| Vision | UNIVERSITY HEALTH ALLIANCE | 285 | $1.4M |
| Life insurance | AFLAC | 88 | $87K |
| Short-term disability | AFLAC | 88 | $87K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 285 | $1.4M |
| Other | AFLAC | 88 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.