| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1039 N MCDOWELL BOULEVARD SUITE A PETALUMA, CA 94954 | KAISER FOUNDATION HEALTH PLAN INC | $95K | $0 | $95K | 4.76% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 8000 NORMAN CENTER DR STE 400 BLOOMINGTON, MN 55437 | METROPOLITAN LIFE INSURANCE COMPANY | $36K | $60 | $36K | 7.93% |
| USI INSURANCE SERVICES LLC3 | 1018 W 9TH AVE STE 100 KING OF PRUSSIA, PA 19406 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $6K | $6K | 1.24% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1039 A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | SUN LIFE ASSURANCE COMPANY OF CANADA | $13K | $0 | $13K | 10.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 1039A N MCDOWELL BLVD PETALUMA, CA 94954 | VISION SERVICE PLAN | $1K | $0 | $1K | 1.72% |
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 | 297 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 311 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 313 | $2.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 684 | $449K |
| Vision | VISION SERVICE PLAN | 300 | $60K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 279 | $128K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 279 | $128K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 313 | $2.0M |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 347 | $137K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 684 | — |
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.