| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | UNITEDHEALTHCARE INSURANCE COMPANY | $173K | $0 | $173K | 2.70% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $33K | $0 | $33K | 2.93% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | DELTA DENTAL OF CALIFORNIA | $31K | $0 | $31K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $3K | $0 | $3K | 1.12% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 2.68% |
| USI INSURANCE SERVICES LLC3 | 3440 WALNUT, BUILDING A, 2ND FLOOR SUITE 33667 FREMONT, CA 94538 | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 2.11% |
| ACE BENEFIT PARTNERS, INC.3 | 1990 NORTH CALIFORNIA BOULEVARD SUITE 900 WALNUT CREEK, CA 94596 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $3K | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, SUITE 1100 SAN FRANCISCO, CA 94105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $627 | $5K | 8.07% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $85 | $2K | 2.86% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $36 | $0 | $36 | 0.06% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $177 | $2K | 3.30% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 2.39% |
| WORKPLACE SOLUTIONS, INC.3 | 120-A GILLS CREEK PARKWAY COLUMBIA, SC 29209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $654 | $0 | $654 | 1.14% |
| CUSTOM BENEFITS PROGRAMS3 Filed as: CUSTOM BENEFITS PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 0.06% |
| KELLEY AND SWAIN, INC3 Filed as: KELLEY AND SWAIN, INC. | 123 MISSION STREET, 26TH FLOOR SAN FRANCISCO, CA 94105 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.01% |
| KATHERINE TIRADO FLORES3 | UNKNOWN MCCLELLAN, CA 95652 | TRIPLE-S SALUD, INC. | $1K | $0 | $1K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 1990 NORTH CALIFORNIA BOULEVARD SUITE 900 WALNUT CREEK, CA 94596 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $2K | $284 | $2K | 10.51% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $281 | $0 | $281 | 1.61% |
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 | 786 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 788 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 879 | $7.9M |
| Dental(3 contracts, 3 carriers) | DELTA DENTAL OF CALIFORNIA | 1,334 | $675K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | 1,514 | $137K |
| Life insurance(4 contracts, 3 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 510 | $213K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 162 | $116K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 121 | $59K |
| Prescription drug(5 contracts, 5 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 879 | $7.9M |
| Other(6 contracts, 5 carriers) | UNITED BEHAVIORAL HEALTH DBA OPTUM | 6,244 | $275K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,244 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.