| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 2421 WEST PEORIA AVENUE PHOENIX, AZ 85029 | WESTERN HEALTH ADVANTAGE | $38K | $0 | $38K | 4.99% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $12K | $0 | $12K | 1.59% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $0 | $4K | 0.58% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COPANY | $4K | $4K | $8K | 18.83% |
| CELITA ANN PEDRO3 | 6705 MIRAVISTA DRIVE ROCKLIN, CA 95677 | AFLAC | $1K | $0 | $1K | 6.07% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | AFLAC | $1K | $0 | $1K | 4.34% |
| ANDY B GLENN II3 Filed as: ANDY B. GLENN II AND OTHER AGENTS | 2999 DOUGLAS BOULEVARD, SUITE 180 ROSEVILLE, CA 95661 | AFLAC | $301 | $0 | $301 | 1.22% |
| RONDA MATHEW3 | 2030 13TH STREET, APARTMENT 3 SACRAMENTO, CA 95818 | AFLAC | $217 | $0 | $217 | 0.88% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $189 | $0 | $189 | 0.77% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $125 | $0 | $125 | 0.51% |
| PETER JAMES SARANTIS3 | 5509 SNOWBRUSH DRIVE ROCKLIN, CA 95677 | AFLAC | $79 | $0 | $79 | 0.32% |
| CELITA ANN PEDRO3 | 6705 MIRAVISTA DRIVE ROCKLIN, CA 95677 | AFLAC | $651 | $0 | $651 | 4.41% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | AFLAC | $299 | $0 | $299 | 2.03% |
| RONDA MATHEW3 Filed as: RONDA MATHEW AND OTHER AGENTS | 2030 13TH STREET, APARTMENT 3 SACRAMENTO, CA 95818 | AFLAC | $217 | $0 | $217 | 1.47% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $147 | $0 | $147 | 1.00% |
| MARCI MARIE OTIS3 | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $98 | $0 | $98 | 0.66% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $76 | $0 | $76 | 0.52% |
| LARS J RONTEN3 Filed as: LARS J. RONTED | 3178 SOFIA DRIVE LINCOLN, CA 95648 | AFLAC | $75 | $0 | $75 | 0.51% |
| CELITA ANN PEDRO3 | 6705 MIRAVISTA DRIVE ROCKLIN, CA 95677 | AFLAC | $195 | $0 | $195 | 3.95% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | AFLAC | $121 | $0 | $121 | 2.45% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $83 | $0 | $83 | 1.68% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS AND OTHER AGENTS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $42 | $0 | $42 | 0.85% |
| LARS J RONTEN3 Filed as: LARS J. RONTED | 3178 SOFIA DRIVE LINCOLN, CA 95648 | AFLAC | $40 | $0 | $40 | 0.81% |
| PETER JAMES SARANTIS3 | 5509 SNOWBRUSH DRIVE ROCKLIN, CA 95677 | AFLAC | $29 | $0 | $29 | 0.59% |
| LAWLEN INSURANCE SOLUTIONS, LLC3 | 1901 66TH AVENUE SACRAMENTO, CA 95822 | AFLAC | $21 | $0 | $21 | 0.43% |
| CELITA ANN PEDRO3 | 6705 MIRAVISTA DRIVE ROCKLIN, CA 95677 | AFLAC | $113 | $0 | $113 | 4.61% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | AFLAC | $62 | $0 | $62 | 2.53% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $57 | $0 | $57 | 2.33% |
| PETER JAMES SARANTIS3 | 5509 SNOWBRUSH DRIVE ROCKLIN, CA 95677 | AFLAC | $28 | $0 | $28 | 1.14% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $18 | $0 | $18 | 0.73% |
| CELITA ANN PEDRO3 | 6705 MIRAVISTA DRIVE ROCKLIN, CA 95677 | AFLAC | $56 | $0 | $56 | 3.80% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | AFLAC | $38 | $0 | $38 | 2.58% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $33 | $0 | $33 | 2.24% |
| DANNY LEON3 Filed as: DANNY J. LEON AND OTHER AGENTS | 162 BARLEY STREET SAINT AUGUSTINE, FL 32092 | AFLAC | $17 | $0 | $17 | 1.15% |
| PETER JAMES SARANTIS3 | 5509 SNOWBRUSH DRIVE ROCKLIN, CA 95677 | AFLAC | $16 | $0 | $16 | 1.09% |
| DANNY J LEON3 Filed as: DANNY J. LEON | 10550 BAYMEADOWS ROAD, UNIT 429 JACKSONVILLE, FL 32256 | AFLAC | $8 | $0 | $8 | 0.54% |
| SLR INSURANCE SOLUTIONS INC3 Filed as: SLR INSURANCE SOLUTIONS, INC. | 179 PINE HAVEN DRIVE ST JOHNS, FL 32259 | AFLAC | $7 | $0 | $7 | 0.48% |
| CELITA ANN PEDRO3 | 6705 MIRAVISTA DRIVE ROCKLIN, CA 95677 | AFLAC | $86 | $0 | $86 | 6.41% |
| LES HEINSEN INS SERVICES INC3 Filed as: LES HEINSEN INS SERV, INC. & AGENTS | 4416 VIA PALAGIO FAIR OAKS, CA 95628 | AFLAC | $22 | $0 | $22 | 1.64% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $14 | $0 | $14 | 1.04% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF CA INS SERV, LLC | 1455 RESPONSE ROAD, SUITE 260 SACRAMENTO, CA 95815 | AFLAC | $13 | $0 | $13 | 0.97% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | AFLAC | $10 | $0 | $10 | 0.75% |
| DARRYL W VIDOR3 Filed as: DARRYL W. VIDOR | 3314 EUROPA STREET ROSEVILLE, CA 95661 | AFLAC | $8 | $0 | $8 | 0.60% |
| JAMES S SARANTIS3 Filed as: JAMES S. SARANTIS | 14132 SE FIRCREST COURT PORTLAND, OR 97236 | AFLAC | $8 | $0 | $8 | 0.60% |
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 | 331 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 331 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | WESTERN HEALTH ADVANTAGE | 230 | $1.5M |
| Life insurance(7 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COPANY | 336 | $92K |
| Short-term disability(6 contracts) | AFLAC | 27 | $50K |
| Prescription drug(2 contracts, 2 carriers) | WESTERN HEALTH ADVANTAGE | 230 | $1.5M |
| Other(7 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COPANY | 336 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 336 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.