| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | P.O. BOX 26949 ATTN WEST VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $64K | — | $64K | 1.34% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES NATIONAL INC | 6100 FAIRVIEW ROAD SUITE 1400 CHARLOTTE, NC 28210 | BLUE CROSS OF CALIFORNIA | $24K | $2K | $26K | 0.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 301 COLLEGE STREET 19TH FLOOR CHARLOTTE, NC 28202 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC | $4K | — | $4K | 1.60% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 6100 FAIRVIEW ROAD 14TH FLOOR CHARLOTTE, NC 28210 | HARTFORD LIFE AND ACCIDENT | $21K | — | $21K | 10.53% |
| USI INSURANCE SERVICES LLC3 | 470 PARK AVE SOUTH FLOOR 6 NEW YORK, NY 10016 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 0.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 301 COLLEGE STREET 19TH FLOOR CHARLOTTE, NC 28202 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC | $1K | — | $1K | 1.60% |
| USI INSURANCE SERVICES LLC3 | 6100 FAIRVIEW ROAD SUITE 1400 CHARLOTTE, NC 282103293 | AMERITAS LIFE INSURANCE CORPORATION | $3K | — | $3K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | 5200 N PALM AVE SUITE 114 FRESNO, CA 937042225 | AMERITAS LIFE INSURANCE CORPORATION | — | $90 | $90 | 0.29% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SVCS USA INC | 5200 N PALM AVE STE 114 FRESNO, CA 937042225 | AMERITAS LIFE INSURANCE CORPORATION | — | $112 | $112 | 0.43% |
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 | 492 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 494 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 997 | $5.3M |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 431 | $26K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORPORATION | 378 | $45K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 492 | $204K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 492 | $204K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 492 | $204K |
| Other | HARTFORD LIFE AND ACCIDENT | 492 | $204K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 997 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.