| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN | $32K | — | $32K | 3.80% |
| USI INSURANCE SERVICES LLC | PO BOX 66119 VIRGINIA BEACH, VA 23466 | WESTERN HEALTH ADVANTAGE | $20K | — | $20K | 4.41% |
| USI INSURANCE SERVICES LLC | PO BOX 66119 VIRGINIA BEACH, VA 23466 | CYPRESS DENTAL ADMINISTRATORS | $4K | — | $4K | 4.85% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | PO BOX 66119 SACRAMENTO, CA 23466 | VISION SERVICE PLAN | $886 | — | $886 | 6.27% |
| USI INSURANCE SERVICES LLC | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $586 | — | $586 | 13.37% |
| USI INSURANCE SERVICES LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $150 | — | $150 | 3.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| RAVEN UNION BENEFITS ADMINISTRATION EIN 93-1700163 | Contract Administrator Service code 13 | 4840 TRINITY COURT SACRAMENTO, CA 95820 | $36K |
| SCHWARTZ PLATZ EIN 68-0263780 19800 | Accounting (including auditing) Service code 10 | 730 HOWE AVE STE 100 SACRAMENTO, CA 95825 | $0 |
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 | 97 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 127 | $1.3M |
| Dental | CYPRESS DENTAL ADMINISTRATORS | 77 | $80K |
| Vision | VISION SERVICE PLAN | 80 | $14K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 97 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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."
No prospect flags tripped on this filing.