| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1000 BURNETT AVENUE, SUITE 330 CONCORD, CA 94520 | AETNA LIFE INSURANCE COMPANY | $62K | $0 | $62K | 5.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 | UNKNOWN PHOENIX, AZ 85012 | AETNA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 0.20% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $17K | $0 | $17K | 4.59% |
| USI INSURANCE SERVICES LLC3 | 1000 BURNETT AVENUE, SUITE 330 CONCORD, CA 94520 | AETNA HEALTH OF CALIFORNIA, INC. | $7K | $0 | $7K | 5.21% |
| USI INSURANCE SERVICES LLC3 | 1001 GALAXY WAY, SUITE 300 CONCORD, CA 94520 | DELTA DENTAL OF CALIFORNIA | $4K | $0 | $4K | 3.52% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $6K | $12K | 18.86% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.32% |
| BALTOR INSURANCE SERVICES3 | 533 AIRPORT BOULEVARD, SUITE 400 BURLINGAME, CA 94010 | AFLAC | $249 | $0 | $249 | 3.04% |
| MARTIN M. MIYAUCHI3 Filed as: MARTIN M. MIYAUCHI AND OTHER AGENTS | 7052 SANTA TERESA BOULEVARD 36 SAN JOSE, CA 95139 | AFLAC | $161 | $0 | $161 | 1.97% |
| BONNIE C. SATO3 | 47201 MISSION FALLS COURT APARTMENT 2248 FREMONT, CA 94539 | AFLAC | $54 | $0 | $54 | 0.66% |
| SHELLY DENISE CAIRES3 | 220 CASCADE DRIVE HIGH POINT, NC 27265 | AFLAC | $50 | $0 | $50 | 0.61% |
| DANIEL L. REED3 | 2021 KOOPMANS AVENUE SANTA CRUZ, CA 95062 | AFLAC | $49 | $0 | $49 | 0.60% |
| CHRIS C NESTER3 Filed as: CHRIS C. NESTER | 1610 PARK TRAIL DRIVE HOLLISTER, CA 95023 | AFLAC | $42 | $0 | $42 | 0.51% |
| RUBEN ROSA3 | 933 LEE ROAD, SUITE 200 ORLANDO, FL 32810 | AFLAC | $41 | $0 | $41 | 0.50% |
| USI INSURANCE SERVICES LLC3 | 1001 GALAXY WAY, SUITE 300 CONCORD, CA 94520 | CLAREMONT BEHAVIORAL SERVICES, INC. | $178 | $0 | $178 | 4.09% |
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 | 102 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | AETNA LIFE INSURANCE COMPANY | 121 | $1.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 190 | $106K |
| Vision | VISION SERVICE PLAN | 91 | $23K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $62K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $71K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $62K |
| Prescription drug(4 contracts, 3 carriers) | AETNA LIFE INSURANCE COMPANY | 121 | $1.7M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.