| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | KAISER FOUNDATION HEALTH PLAN, INC | — | — | $0 | 0.00% |
| ATLAS INSURANCE AGENCY, INC.3 | 1132 BISHOP STREET, SUITE 1600 HONOLULU, HI 96813 | HAWAII DENTAL SERVICE | $2K | — | $2K | 1.00% |
| ATLAS INSURANCE AGENCY, INC. | 1132 BISHOP STREET, SUITE 1600 HONOLULU, HI 96813 | CIGNA GROUP INSURANCE | $3K | — | $3K | 14.85% |
| NONE | — | DENTAL CARE CENTERS OF HAWAII | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HAWAII BENEFIT ADMINISTRATORS, INC EIN 99-6005504 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 200 N. VINEYARD BLVD., SUITE 100 HONOLULU, HI 96817 | $120K |
| ENVISION NONE | Claims processing; Direct payment from the plan Service code 12 | 2181 E. AURORA ROAD TWINSBURG, OH 44087 | $18K |
| JAMES P HASSELMAN CPA LLC EIN 20-5496781 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | P.O. BOX 11149 HONOLULU, HI 96828 | $18K |
| FIRST HAWAIIAN BANK EIN 99-0034327 NONE | Investment management; Custodial (securities); Investment management fees paid indirectly by plan; Direct payment from the plan Service code 19 | 999 BISHOP STREET HONOLULU, HI 96813 | $11K |
| WEINBERG, ROGER & ROSENFELD EIN 94-2458080 NONE | Legal; Direct payment from the plan Service code 29 | — | $10K |
| UBS FINANCIAL SERVICES NONE | Investment advisory (plan); Direct payment from the plan; Investment management fees paid indirectly by plan Service code 27 | 733 BISHOP STREET, SUITE 1600 HONOLULU, HI 96813 | $7K |
| SYSTEM DESIGN ASSOCIATES NONE | Copying and duplicating; Direct payment from the plan Service code 36 | 900 S HIGHWAY DRIVE, SUITE 102 FENTOM, MO 63026 | $6K |
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 | 234 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 234 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HMAA | 392 | $1.4M |
| Dental(2 contracts, 2 carriers) | HAWAII DENTAL SERVICE | 551 | $166K |
| Life insurance | CIGNA GROUP INSURANCE | 213 | $21K |
| Other | CIGNA GROUP INSURANCE | 213 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 551 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.