| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $16K | $0 | $16K | 2.98% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN VIRGINIA BEACH, VA 23462 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $13K | $0 | $13K | 9.94% |
| MARY KOCH3 Filed as: MARY KOCH AND OTHER AGENTS | 1012 EMMA ROSE BOULEVARD BRENTWOOD, CA 94513 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $735 | $3K | 6.16% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $156 | $2K | 3.90% |
| BRIAN ROBERT LLOYD3 | 1781 VINEYARD DRIVE, SUITE 225 ANTIOCH, CA 94509 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $973 | $870 | $2K | 3.52% |
| WAYNE RIMMER3 Filed as: WAYNE P. SMITH | 1113 WEST GROVE WAY COUER DALENE, ID 83815 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.92% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 3247 WEST MARCH LANE STOCKTON, CA 95219 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $985 | $0 | $985 | 1.88% |
| STEPHANIE NOELLE KUGLER3 | 336 PACIFICA DRIVE BRENTWOOD, CA 94513 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $485 | $109 | $594 | 1.14% |
| AMBER MARIE PASSAGLIA3 | 3413 DEL CHIARO WAY CONCORD, CA 94518 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $223 | $371 | $594 | 1.14% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FIN. SVCS., INC. | 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 9.89% |
| AGIS NETWORK INC3 Filed as: AGIS NETWORK, INC. | 2122 KRATKY ROAD SAINT LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 9.89% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FIN. SVCS., INC. | 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.38% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | $0 | $2K | 9.35% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES NORTHWEST | 3247 WEST MARCH LANE, SUITE 210 STOCKTON, CA 95219 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $989 | $0 | $989 | 10.00% |
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 | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 89 | $529K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 177 | $133K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 302 | $19K |
| Life insurance(3 contracts, 3 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 198 | $94K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 196 | $84K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 89 | $529K |
| Other(5 contracts, 5 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 252 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 302 | — |
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.