Form 5500 · Employee benefit plan · KIHEI MAUI, HI
WC MAUI COAST HOTEL LLC
The filing calls this plan MAUI COAST HOTEL MEDICAL PLAN.
WC MAUI COAST HOTEL LLC of KIHEI MAUI, HI is a 101-participant hospitality and food service employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is USI INSURANCE SERVICES NORTHWEST. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC.. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 91-1934339 · plan 501 · plan year 2025, filed Jan 7, 2026
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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
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.
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
The filing discloses a single insured line, health, through KAISER FOUNDATION HEALTH PLAN, INC., covering 193 people.
Reported premium across the insured contracts is $1,324,376, with $45,977 in disclosed broker commissions — about 3.5% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 193 | Jun 1, 2025 | $1,324,376 | $45,977 |
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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