| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 2021 WEST MARCH LANE, 3RD FLOOR STOCKTON, CA 95207 | AETNA LIFE INSURANCE COMPANY | $93K | — | $93K | 4.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 2021 WEST MARCH LANE, 3RD FLOOR STOCKTON, CA 95207 | AETNA HEALTH, INC. | $30K | — | $30K | 4.15% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1390 WILLOW PASS ROAD, SUITE 410 CONCORD, CA 94520 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $25K | — | $25K | 4.31% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | KAISER FOUNDATION HEALTH PLAN INC | $20K | — | $20K | 4.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC. | — | $5K | $5K | 3.29% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 300 EAST MAIN STREET, SUITE 1300 NORFOLK, VA 23510 | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC. | $4K | — | $4K | 2.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $2K | — | $2K | 4.24% |
| RHONA S UNSELL INC4 Filed as: RHONA S. UNSELL, INC. | 6525 GUNPARK DRIVE, SUITE 370-152 BOULDER, CO 80301 | PRE-PAID LEGAL SERVICES, INC. | $2K | — | $2K | 22.89% |
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 | 301 | 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) | 301 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | AETNA LIFE INSURANCE COMPANY | 515 | $3.6M |
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 383 | $576K |
| Vision | VISION SERVICE PLAN | 286 | $37K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 383 | $576K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 383 | $576K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 383 | $576K |
| Prescription drug(4 contracts, 4 carriers) | AETNA LIFE INSURANCE COMPANY | 515 | $3.6M |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 383 | $584K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 515 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.