| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 7369 STOCKTON, CA 95267 | BLUE CROSS OF CALIFORNIA | $57K | — | $57K | 6.09% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | BLUE CROSS OF CALIFORNIA | — | $5K | $5K | 0.54% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 2.99% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FINANCIAL SVCS. | 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | — | $7K | 10.85% |
| AGIS NETWORK INC3 Filed as: AGIS NETWORK, INC. | 2122 KRATKY ROAD SAINT LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $494 | $6K | 10.74% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FINANCIAL SVCS. | 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 9.87% |
| LISA M KELLEY3 Filed as: LISA M. KELLY | 2019 LUGANO COURT MANTECA, CA 95337 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $9 | $1K | 3.32% |
| WAYNE RIMMER3 Filed as: WAYNE P. SMITH | 14442 BORA DRIVE LA MIRANDA, CA 90638 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 2.88% |
| CHERYL D SMITH3 Filed as: CHERYL D. SMITH | 14442 BORA DRIVE LA MIRADA, CA 90638 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $453 | — | $453 | 1.12% |
| HOLLERN & ASSOCIATES INCORPORATED3 Filed as: HOLLERN AND ASSOCIATES INCORPORATED | 11412 ROBBIA DRIVE LAS VEGAS, NV 89138 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $349 | $7 | $356 | 0.88% |
| G SCOTT COOKE3 Filed as: SCOTT ALLEN BEER | 829 CYNTHIA DRIVE WATSONVILLE, CA 95076 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $123 | $58 | $181 | 0.45% |
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 | 198 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 347 | $1.4M |
| Dental | BLUE CROSS OF CALIFORNIA | 347 | $928K |
| Vision | BLUE CROSS OF CALIFORNIA | 347 | $928K |
| Life insurance(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 347 | $1.0M |
| Short-term disability(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $102K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $61K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 347 | $1.4M |
| Other(5 contracts, 5 carriers) | BLUE CROSS OF CALIFORNIA | 347 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 347 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.