Form 5500 · Employee benefit plan · TUMON BAY
PREMIER KEN GUAM L.P. DBA HILTON GUAM RESORT & SPA
The filing calls this plan PREMIER KEN GUAM LP DBA HILTON GUAM RESORT & SPA SECTION 125 CAF PLAN.
PREMIER KEN GUAM L.P. DBA HILTON GUAM RESORT & SPA of TUMON BAY, GU insures health, dental and life coverage for its employees, per Schedule A of its Form 5500. Coverage is written through TAKECARE and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 66-0696667 · plan 501 · plan year 2024, filed Aug 20, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
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 4 insured contracts covering health, dental and life; the largest, with TAKECARE, covers 303 people.
The filing declares health, dental, life and vision. Vision appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
Reported premium is $1,087,589; the filing discloses no broker commission on these contracts.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in March. The plan is on a split renewal cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| TAKECARE | Health, Dental | 303 | Jan 1, 2025 | $964,554 | $0 |
| AFLAC | — | 56 | Jan 1, 2025 | $46,090 | $0 |
| METROPOLITAN LIFE INSURANCE COMPANY | Life | 408 | Apr 1, 2025 | $45,135 | $0 |
| TRANSAMERICA LIFE INSURANCE COMPANY | Life | 78 | Jan 1, 2025 | $31,810 | $0 |
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. We publish company names only.
Other plans filed by this employer
How this plan compares
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