| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | UNITEDHEALTHCARE INSURANCE COMPANY | $58K | $0 | $58K | 2.99% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $22K | $0 | $22K | 2.56% |
| USI INSURANCE SERVICES LLC3 | 1039-A N. MCDOWELL BLVD. PETALUMA, CA 94954 | DELTA DENTAL OF CALIFORNIA | $10K | $0 | $10K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 3247 WEST MARCH LANE, SUITE 210 STOCKTON, CA 95219 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $1K | $8K | 12.39% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $189 | $14 | $203 | 0.31% |
| ACE BENEFIT PARTNERS, INC.3 | 1990 NORTH CALIFORNIA BOULEVARD SUITE 900 WALNUT CREEK, CA 94596 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $699 | $0 | $699 | 2.79% |
| USI INSURANCE SERVICES LLC3 | 3440 WALNUT, BUILDING A, 2ND FLOOR SUITE 33667 FREMONT, CA 94538 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $437 | $0 | $437 | 1.74% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $588 | $0 | $588 | 7.42% |
| USI INSURANCE SERVICES LLC3 | PO BOX 666119 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $117 | $0 | $117 | 1.48% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $0 | $76 | $76 | 0.96% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $738 | $91 | $829 | 27.96% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18 | $0 | $18 | 0.61% |
| WORKPLACE SOLUTIONS, INC.3 | 120-A GILLS CREEK PARKWAY COLUMBIA, SC 29209 | FIRST UNUM LIFE INSURANCE COMPANY | $45 | $0 | $45 | 3.57% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | FIRST UNUM LIFE INSURANCE COMPANY | $12 | $0 | $12 | 0.95% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | FIRST UNUM LIFE INSURANCE COMPANY | $6 | $0 | $6 | 0.48% |
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 | 285 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 215 | $2.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 487 | $209K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 368 | $25K |
| Life insurance(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 282 | $103K |
| Short-term disability(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 29 | $71K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 29 | $67K |
| Prescription drug(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 215 | $2.8M |
| Other(5 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 296 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 487 | — |
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.