| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $30K | $0 | $30K | 2.98% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | DELTA DENTAL OF CALIFORNIA | $32K | $0 | $32K | 5.21% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $6K | $0 | $6K | 2.22% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $2K | $8K | 6.62% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $33 | $0 | $33 | 0.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 5.13% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $218 | $2K | 3.99% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 2.16% |
| WORKPLACE SOLUTIONS, INC.3 | 120A GILLS CREEK PARKWAY COLUMBIA, SC 29209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $551 | $0 | $551 | 0.95% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $37 | $0 | $37 | 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 | $8 | $0 | $8 | 0.01% |
| KATHERINE TIRADO FLORES3 | UNKNOWN MCCLELLAN, CA 95652 | TRIPLE-S SALUD, INC. | $2K | $0 | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $2K | $57 | $2K | 10.26% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $0 | $243 | $243 | 1.20% |
| USI INSURANCE SERVICES LLC3 | PO BOX 64422 ST PAUL, MN 55164 | METLIFE LEGAL PLANS | $0 | $57 | $57 | 0.28% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | METLIFE LEGAL PLANS | $0 | -$37 | -$37 | -0.18% |
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 | 878 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 882 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 215 | $1.4M |
| Dental(3 contracts, 3 carriers) | DELTA DENTAL OF CALIFORNIA | 1,383 | $703K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | 1,165 | $159K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 440 | $183K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 146 | $58K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 215 | $1.4M |
| Other(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 7,690 | $189K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,690 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.