| 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. | $46K | $0 | $46K | 2.85% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $6K | $0 | $6K | 2.18% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $6K | $17K | 8.06% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $27 | $0 | $27 | 0.01% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $7K | $0 | $7K | 4.92% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $374 | $5K | 8.20% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $287 | $0 | $287 | 0.47% |
| WORKPLACE SOLUTIONS, INC.3 | 120-A GILLS CREEK PARKWAY COLUMBIA, SC 29209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $267 | $0 | $267 | 0.44% |
| CUSTOM BENEFITS PROGRAMS3 Filed as: CUSTOM BENEFITS PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $23 | $0 | $23 | 0.04% |
| KELLEY AND SWAIN, INC3 Filed as: KELLEY & 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. | $3K | $0 | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $4K | $294 | $5K | 10.87% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62989 VIRGINA BEACH, VA 23466 | METLIFE LEGAL PLANS | $0 | $143 | $143 | 0.33% |
| USI INSURANCE SERVICES LLC3 | 11017 COBBLEROCK DRIVE, SUITE 100 RANCHO CORDOVA, CA 95670 | METLIFE LEGAL PLANS | $0 | $81 | $81 | 0.19% |
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 | 1,135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 230 | $2.0M |
| Dental(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 10 | $108K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,496 | $202K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 708 | $273K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 121 | $61K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 230 | $2.0M |
| Other(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 10,686 | $438K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,686 | — |
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."
No prospect flags tripped on this filing.