| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $31K | $3K | $33K | 2.22% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $0 | $9K | 6.60% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $4K | $4K | 2.60% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $4K | $0 | $4K | 2.99% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.30% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $422 | $0 | $422 | 4.86% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $31 | $31 | 0.36% |
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 | 194 | 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) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 166 | $1.5M |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 213 | $137K |
| Vision | VISION SERVICE PLAN | 158 | $22K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 194 | $144K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 194 | $144K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 194 | $144K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 166 | $1.5M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 194 | $159K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 213 | — |
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."
No prospect flags tripped on this filing.