| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $29K | $0 | $29K | 6.30% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN, INC. | $96 | $0 | $96 | 0.02% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | BLUECROSS BLUESHIELD OF ILLINOIS | $10K | $2 | $10K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $859 | $6K | 6.72% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | SUTTER HEALTH PLAN | $3K | $0 | $3K | 5.00% |
| RUMBAUGH ONE INSURANCE SOLUTIONS3 Filed as: RUMBAUGH ONE INS SOLUTIONS, INC. | 1390 BROADWAY, SUITE B-125 PLACERVILLE, CA 95667 | AFLAC | $750 | $0 | $750 | 16.41% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | AFLAC | $198 | $0 | $198 | 4.33% |
| EMPLOYERS SELECT INSURANCE SERVICES3 | 5701 LONETREE BOULEVARD, SUITE 111 ROCKLIN, CA 95765 | AFLAC | $171 | $0 | $171 | 3.74% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, LLC | 5701 LONETREE BOULEVARD, SUITE 111 ROCKLIN, CA 95765 | AFLAC | $139 | $0 | $139 | 3.04% |
| COLLEEN LEWIS3 Filed as: COLLEEN LEWIS AND OTHER AGENTS | 16676 NEW YORK HOUSE ROAD BROWNSVILLE, CA 95919 | AFLAC | $132 | $0 | $132 | 2.89% |
| KEVIN S. SMEDES3 | 4180 WIGGINS COURT RANCHO CORDOVA, CA 95742 | AFLAC | $74 | $0 | $74 | 1.62% |
| PETER JAMES SARANTIS3 | 5509 SNOWBRUSH DRIVE ROCKLIN, CA 95677 | AFLAC | $72 | $0 | $72 | 1.58% |
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 | 159 | 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) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 99 | $734K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 211 | $84K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 211 | $84K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 211 | $88K |
| Short-term disability | AFLAC | 6 | $5K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 99 | $734K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 211 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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.