| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | CALIFORNIA PHYSICIANS SERVICE | $14K | $33K | $47K | 5.81% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $21K | $0 | $21K | 3.26% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FINANCIAL SERVICE | 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 10.14% |
| AGIS NETWORK INC3 Filed as: AGIS NETWORK, INC. | 2122 KRATKY ROAD SAINT LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 10.14% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $154 | $4K | 9.15% |
| WAYNE P. SMITH AND OTHER AGENTS3 | 3374 NORTH PARK CROSSING AVENUE MERIDIAN, ID 83646 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $1K | $2K | 4.81% |
| BRITTANY LLOYD3 | PO BOX 4942 EL DORADO HILLS, CA 95762 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $1K | $2K | 4.22% |
| CANDICE ELISE EUSEBIO3 | 124 AMBERSTONE LANE SAN RAMON, CA 94582 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $118 | $2K | 3.35% |
| CASEY JAMES KUGLER3 | 906 HAWKS FEATHER LANE ROCKLIN, CA 95765 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $284 | $764 | $1K | 2.14% |
| BRIAN ROBERT LLOYD3 | PO BOX 11 KNIGHTSEN, CA 94548 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $431 | $510 | $941 | 1.92% |
| STEPHANIE NOELLE KUGLER3 | 906 HAWKS FEATHER LANE ROCKLIN, CA 95765 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $583 | $204 | $787 | 1.61% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FINANCIAL SERVICE | 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.40% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $894 | $0 | $894 | 5.84% |
| STEPHANIE NOELLE KUGLER3 Filed as: STEPHANIE N. KUGLER AN OTHER AGENTS | 906 HAWKS FEATHER LANE ROCKLIN, CA 95765 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $356 | $47 | $403 | 2.63% |
| BRITTANY LLOYD3 | PO BOX 4942 EL DORADO HILLS, CA 95762 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $181 | $205 | $386 | 2.52% |
| BRIAN ROBERT LLOYD3 | PO BOX 11 KNIGHTSEN, CA 94548 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $123 | $70 | $193 | 1.26% |
| CANDICE ELISE EUSEBIO3 | 124 AMBERSTONE LANE SAN RAMON, CA 94582 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $191 | $0 | $191 | 1.25% |
| WAYNE RIMMER3 Filed as: WAYNE P. SMITH | 3374 NORTH PARK CROSSING AVENUE MERIDIAN, ID 83646 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $190 | $0 | $190 | 1.24% |
| CASEY JAMES KUGLER3 | 906 HAWKS FEATHER LANE ROCKLIN, CA 95765 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $54 | $130 | $184 | 1.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $960 | $0 | $960 | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $242 | $0 | $242 | 9.99% |
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 | 212 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 134 | $1.5M |
| Dental | CALIFORNIA PHYSICIANS SERVICE | 97 | $811K |
| Vision | CALIFORNIA PHYSICIANS SERVICE | 97 | $811K |
| Life insurance(5 contracts, 3 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 213 | $108K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 212 | $31K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 134 | $1.5M |
| Other(7 contracts, 5 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 283 | $165K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 283 | — |
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.