| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN | $21K | — | $21K | 2.15% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN | $14K | — | $14K | 1.49% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES LL | PO BOX 66119 VIRGINIA BEACH, VA 23466 | WESTERN HEALTH ADVANTAGE | $22K | — | $22K | 4.00% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | PO BOX 66119 VIRGINIA BEACH, VA 23466 | CYPRESS DENTAL ADMINISTRATORS | $4K | — | $4K | 5.00% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $900 | — | $900 | 6.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VALLEY ADMINISTRATORS EIN 94-1651216 | Contract Administrator Service code 13 | PO BOX 40 RANCHO CORDOVA, CA 95741 | $21K |
| SCHWARTZ PLATZ EIN 68-0263780 | Accounting (including auditing) Service code 10 | 730 HOWE AVE STE 100 SACRAMENTO, CA 95825 | $18K |
| AMANDA KNIGHT | Contract Administrator Service code 13 | 2990 MENDEL WAY SACRAMENTO, CA 95833 | $8K |
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 | 129 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 184 | $1.5M |
| Dental | CYPRESS DENTAL ADMINISTRATORS | 95 | $81K |
| Vision | VISION SERVICE PLAN | 103 | $14K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 119 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.