| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY, INC | 201 MERCHANT STREET STE 1100 HONOLULU, HI 96813 | UNIVERSITY HEALTH ALLIANCE | $30K | — | $30K | 2.77% |
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY, INC | 201 MERCHANT STREET STE 1100 HONOLULU, HI 96813 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 3.45% |
| ATLAS INSURANCE AGENCY, INC.3 | 201 MERCHANT STREET STE 1100 HONOLULU, HI 96813 | HAWAII DENTAL SERVICE | $2K | — | $2K | 1.99% |
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY, INC | 201 MERCHANT STREET STE 1100 HONOLULU, HI 96813 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY, INC | 201 MERCHANT STREET STE 1100 HONOLULU, HI 96813 | 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 | $1K | — | $1K | 12.53% |
| JEANICE LYN GEYROZAGA3 | 2888 ALA LLIMA ST APT 2209 HONOLULU, HI 96818 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $128 | $16 | $144 | 1.49% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 0.83% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.04% |
| ATLAS INSURANCE AGENCY, INC.3 Filed as: ATLAS INSURANCE AGENCY, INC | 201 MERCHANT STREET STE 1100 HONOLULU, HI 96813 | VISION SERVICE PLAN | -$162 | — | -$162 | -18.16% |
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 | 313 | 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) | 316 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | UNIVERSITY HEALTH ALLIANCE | 194 | $1.7M |
| Dental | HAWAII DENTAL SERVICE | 324 | $101K |
| Vision(4 contracts, 4 carriers) | UNIVERSITY HEALTH ALLIANCE | 194 | $1.6M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 268 | $20K |
| Prescription drug(4 contracts, 4 carriers) | UNIVERSITY HEALTH ALLIANCE | 194 | $1.7M |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 313 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.