| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $49K | $0 | $49K | 2.49% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 700 NE MULTNOMAH STREET, SUITE 1300 PORTLAND, OR 97232 | PROVIDENCE HEALTH PLAN | $49K | $0 | $49K | 2.98% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 6.73% |
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 23514 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 1.55% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $202 | $202 | 0.16% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES NORTHWEST | 700 NE MULTNOMAH STREET, SUITE 1300 PORTLAND, OR 97232 | QBE INSURANCE CORPORATION | $120 | $0 | $120 | 15.00% |
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 | 544 | 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) | 544 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 273 | $3.6M |
| Dental | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 273 | $2.0M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 544 | $127K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 544 | $127K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 273 | $3.6M |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 730 | $162K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 730 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.