| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI OF SOUTHERN CALIFORNIA INSURANC | 1700 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 91367 | ANTHEM BLUE CROSS | $12K | — | $12K | 2.60% |
| JTW & ASSOCIATES INC3 | 940 S COAST DR #190 COSTA MESA, CA 92626 | ANTHEM BLUE CROSS | $5K | — | $5K | 1.15% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 6393 OAK TREE BLVD INDEPENDENCE, OH 44131 | ANTHEM BLUE CROSS | $4K | — | $4K | 0.82% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 234662949 | KAISER FOUNDATION HEALTH PLAN INC | $15K | — | $15K | 3.24% |
| JTW & ASSOCIATES INC3 Filed as: JTW & ASSOCIATES, INC | 940 S COAST DR STE 190 COSTA MESA, CA 926267798 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 1.52% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 234662949 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 3.40% |
| JTW & ASSOCIATES INC3 Filed as: JTW & ASSOCIATES, INC | 940 S COAST DR STE 190 COSTA MESA, CA 926267798 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 1.54% |
| USI INSURANCE SERVICES LLC Filed as: USI OF SOUTHERN CALIFORNIA INS SVCS | 38 DISCOVERY STE 250 IRVINE, CA 926183129 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 3.75% |
| JTW & ASSOCIATES INC3 | 940 S COAST DR STE 190 COSTA MESA, CA 926267798 | UNITEDHEALTHCARE INSURANCE COMPANY | $447 | — | $447 | 0.56% |
| USI INSURANCE SERVICES LLC3 | 38 DISCOVERY STE 250 IRVINE, CA 926183129 | UNITEDHEALTHCARE INSURANCE COMPANY | $157 | — | $157 | 0.20% |
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 | 260 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 260 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | ANTHEM BLUE CROSS | 94 | $1.2M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 260 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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.