| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1039A N MCDOWELL BLVD PETALUMA, CA 94954 | SUTTER HEALTH PLAN | $18K | — | $18K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 150 N MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 5.05% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $2K | $6K | 8.99% |
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 | 109 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 85 | $699K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 109 | $72K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 109 | $72K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 109 | $72K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 85 | $699K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 109 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 109 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.