| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $30K | $993 | $31K | 1.82% |
| USI INSURANCE SERVICES LLC3 | 6100 FAIRVIEW ROAD, SUITE 1400 CHARLOTTE, NC 28210 | BLUE CROSS OF CALIFORNIA | $0 | $2K | $2K | 0.15% |
| USI INSURANCE SERVICES LLC3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $9K | $0 | $9K | 1.40% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $880 | $0 | $880 | 0.14% |
| USI INSURANCE SERVICES LLC3 | 1039A NORTH MCDOWELL BOULEVARD 1ST FLOOR, SUITE A PETALUMA, CA 94954 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $4 | $6K | 10.50% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 4.03% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, SUITE 1100 SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $43 | $43 | 0.07% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFITS ADV. | ONE BEACON STREET, SUITE 17100 BOSTON, MA 02108 | UNUM LIFE INSURANCE COMPANY OF AMERICA | -$649 | $0 | -$649 | -1.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2121 NORTH CALIFORNIA BOULEVARD SUITE 350 WALNUT CREEK, CA 94596 | ZURICH AMERICAN INSURANCE COMPANY | $150 | $0 | $150 | 15.00% |
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 | 125 | 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) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 146 | $2.4M |
| Dental | BLUE CROSS OF CALIFORNIA | 146 | $1.7M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 111 | $58K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 111 | $58K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 111 | $58K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 146 | $2.4M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 125 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.