| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $147K | $0 | $147K | 5.13% |
| USI INSURANCE SERVICES LLC3 | 1000 BURNETT AVENUE, SUITE 330 CONCORD, CA 94520 | AETNA HEALTH OF CALIFORNIA, INC. | $21K | $0 | $21K | 5.07% |
| USI INSURANCE SERVICES LLC3 | 1000 BURNETT AVENUE, SUITE 330 CONCORD, CA 94520 | AETNA LIFE INSURANCE COMPANY | $16K | $200 | $17K | 5.06% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $2K | $16K | 17.75% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $2K | $0 | $2K | 2.79% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $1 | $5K | 9.84% |
| JB CREATIVE SOLUTIONS LLC3 Filed as: JB CREATIVE SOLUTIONS, LLC | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $40 | $1K | 2.66% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $671 | $34 | $705 | 1.44% |
| DAVID A. RACKLIFFE3 | 300 HEROIT COURT SPRING HILL, TN 37174 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $531 | $2 | $533 | 1.09% |
| JENNIFER AURORA RAMIREZ3 | 4120 WHITTIER STREET SAN DIEGO, CA 92107 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $152 | $0 | $152 | 0.31% |
| REBECCA J. DEERR3 | 16379 EAST PRESERVE LOOP SUITE 2004 CHINO, CA 91708 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | $0 | $4K | 14.62% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | $0 | $4K | 14.07% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 5025 NORTH RIMHURST AVENUE COVINA, CA 91724 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | $0 | $2K | 7.87% |
| MARIAN ELIZABETH LENCIONI3 | 12859 CRAIG DRIVE RANCHO CUCAMONGO, CA 91739 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | $0 | $2K | 5.89% |
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 | 627 | 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) | 627 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 623 | $3.6M |
| Dental | AETNA LIFE INSURANCE COMPANY | 623 | $329K |
| Vision | VISION SERVICE PLAN | 346 | $69K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 627 | $137K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 37 | $77K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 627 | $88K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 623 | $3.6M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 627 | $165K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 627 | — |
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.