| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PSH INSURANCE, INC.3 | 733 BISHOP STREET, SUITE 2120 HONOLULU, HI 96813 | HMAA | $22K | — | $22K | 2.86% |
| PSH INSURANCE, INC.3 | 737 BISHOP ST., #2120 HONOLULU, HI 96813 | KAISER FOUNDATION HEALTH PLAN, INC. | $10K | — | $10K | 3.58% |
| PSH INSURANCE, INC.3 | 737 BISHOP STREET, SUITE 2120 HONOLULU, HI 96813 | HAWAII DENTAL SERVICE | $3K | — | $3K | 2.26% |
| LIANE CHONG3 | SUITE 301 765 AMANA ST HONOLULU, HI 96814 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 14.68% |
| AMERICAN MUTUAL UNDERWRITERS LTD3 | SUITE 1000 1357 KAPIOLANI BLVD HONOLULU, HI 96814 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 3.67% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | — | $60 | $60 | 0.16% |
| PSH INSURANCE, INC.3 | 737 BISHOP STREET, SUITE 2120 HONOLULU, HI 96813 | AETNA LIFE INSURANCE COMPANY | $2K | — | $2K | 8.50% |
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 | 193 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HMAA | 262 | $1.1M |
| Dental | HAWAII DENTAL SERVICE | 357 | $125K |
| Vision(3 contracts, 3 carriers) | HMAA | 262 | $1.1M |
| Life insurance | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 167 | $38K |
| Prescription drug(3 contracts, 3 carriers) | HMAA | 262 | $1.1M |
| Other | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 167 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 357 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.