| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | PO BOX 203373 DALLAS, TX 75320 | KAISER FOUNDATION HEALTH PLAN INC | $55K | — | $55K | 2.50% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS LLC | 1850 GATEWAY DR STE 600 SAN MATEO, CA 944044060 | KAISER FOUNDATION HEALTH PLAN INC | $45K | — | $45K | 2.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 45 FREMONT ST 18TH FLOOR STE 800 SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $2K | $7K | 2.15% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $575 | — | $575 | 0.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 45 FREMONT ST 18TH FLOOR STE 800 SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $2K | $6K | 2.73% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $419 | — | $419 | 0.21% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | PO BOX 39000 SAN FRANCISCO, CA 94139 | VISION SERVICE PLAN | $2K | — | $2K | 1.51% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DR STE 600 SAN MATEO, CA 944044060 | VISION SERVICE PLAN | $1K | — | $1K | 0.73% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 45 FREMONT ST 18TH FLOOR STE 800 SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $774 | $4K | 4.13% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $648 | — | $648 | 0.66% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 45 FREMONT ST 18TH FLOOR STE 800 SAN FRANCISCO, CA 94105 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $232 | $2K | 6.54% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $819 | — | $819 | 2.72% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 45 FREMONT ST STE 800 SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $272 | $4K | 21.69% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS NATIONAL INC | 49 FREMONT ST STE 800 SAN FRANCISCO, CA 94105 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $135 | $1K | 17.05% |
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 | 657 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 86 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 743 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 392 | $2.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,429 | $687K |
| Vision | VISION SERVICE PLAN | 634 | $144K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 844 | $317K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 664 | $98K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 649 | $204K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 392 | $2.2M |
| Other(4 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 729 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,429 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.