| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ADVANTAGE INSURANCE SERVICES, INC. | 1580 MAKALOA STREET #1220 HONOLULU, HI 96814 | UNIVERSITY HEALTH ALLIANCE | $24K | $62K | $86K | 10.92% |
| ADVANTAGE INSURANCE SERVICES, INC.3 | 1580 MAKALOA STREET #1220 HONOLULU, HI 96814 | KAISER FOUNDATION HEALTH PLAN, INC. | $14K | $1 | $14K | 3.42% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | — | HEALTH PLAN OF NEVADA/SIERRA HEALTH & LIFE | $2K | — | $2K | 3.33% |
| ADVANTAGE INSURANCE SERVICES, INC. | 1585 KAPIOLANI BLVD, SUITE 1120 HONOLULU, HI 96814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| RITA S. ORNELLAS3 | 95-1023 HOAILONA STREET MILILANI, HI 96789 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $434 | $2 | $436 | 4.59% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.20% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.04% |
| TAMMY VAN HOUTEN-THOMPSON3 Filed as: TAMMY VAN-HOUTEN-THOMPSON | 8693 TARA HILL AVENUE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.04% |
| CHRISTINA D POLK INC3 | 8972 ECHO RIDGE DRIVE LAS VEGAS, NV 89117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| ADVANTAGE INSURANCE SERVICES, INC. | 1585 KAPIOLANI BLVD, SUITE 1120 HONOLULU, HI 96814 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $621 | — | $621 | 10.00% |
| ADVANTAGE INSURANCE SERVICES, INC.3 | 1580 MAKALOA STREET #1220 HONOLULU, HI 96814 | VSP VISION CARE | $69 | — | $69 | 10.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNIVERSITY HEALTH ALLIANCE EIN 99-0263440 BROKER | Insurance brokerage commissions and fees Service code 53 | 700 BISHOP STREET, SUITE 300 HONOLULU, HI 96813 | $24K |
| KAISER FOUNDATION HEALTH PLAN INC EIN 94-1340523 BROKER | Insurance brokerage commissions and fees Service code 53 | ATTN 5500 TEAM 3840 MURPHY CANYON ROAD SAN DIEGO, CA 92123 | $14K |
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 | 246 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 246 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | UNIVERSITY HEALTH ALLIANCE | 155 | $1.3M |
| Vision(5 contracts, 5 carriers) | UNIVERSITY HEALTH ALLIANCE | 155 | $1.3M |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 246 | $32K |
| Prescription drug(4 contracts, 4 carriers) | UNIVERSITY HEALTH ALLIANCE | 155 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.