Form 5500 · Employee benefit plan · HONOLULU, HI
HSTA VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION TRUST
The filing calls this plan VOLUNTARY EMPLOYEES BENEFICIARY TRUST.
HSTA VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION TRUST of HONOLULU, HI spreads its employee benefits across 5 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is AGIS NETWORK INSURANCE SERVICE. Coverage is written through UNUM LIFE INSURANCE COMPANY OF AMERICA and 4 other carriers. The plan's most recent policy period ended in April.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 23-7296050 · plan 505 · plan year 2025, filed Jun 1, 2026
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How this plan is funded
Self-funded as reported
The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Disability: the largest of the 2 insured disability contracts, with AMERICAN FIDELITY ASSURANCE COMPANY, covers 445 of 7,794 participants (5.7%) on Schedule A.
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 6 insured contracts covering health, life and disability; the largest, with UNUM LIFE INSURANCE COMPANY OF AMERICA, covers 7,027 people.
Reported premium across the insured contracts is $5,634,289, with $210,794 in disclosed broker commissions — about 3.7% of premium.
The health contract's policy period ended in April, while at least one ancillary line's policy period ended in August. The plan is on a split renewal cycle.
AGIS NETWORK INSURANCE SERVICE is the broker of record on 1 of the 6 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including UNUM LIFE INSURANCE COMPANY OF AMERICA, PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD., METROPOLITAN LIFE INSURANCE COMPANY and AMERICAN FIDELITY ASSURANCE COMPANY. UNUM LIFE INSURANCE COMPANY OF AMERICA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | — | 7,027 | Aug 2, 2025 | $4,260,055 | $210,794 |
| PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD. | Life | 7,640 | Sep 1, 2025 | $567,268 | $0 |
| METROPOLITAN LIFE INSURANCE COMPANY | Health | 1,134 | May 1, 2025 | $369,266 | $0 |
| AMERICAN FIDELITY ASSURANCE COMPANY | Disability | 445 | Oct 1, 2025 | $251,832 | $0 |
| HARTFORD LIFE AND ACCIDENT | Disability | 453 | Sep 1, 2025 | $122,349 | $0 |
| METROPOLITAN LIFE INSURANCE COMPANY | Health | 722 | May 1, 2025 | $63,519 | $0 |
Premium and claims on this contract
PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD., contract 41000. For the contract year on this filing, the carrier reported $567,268 in premium earned and $463,195 in claims incurred. Dividing one by the other gives 82%.
- PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LTD., contract 41000 reported $62,399 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
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