| 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 | $45K | $1K | $46K | 1.02% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $36K | $2K | $38K | 15.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | PACIFICSOURCE HEALTH PLANS | $3K | $0 | $3K | 2.11% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $3K | $0 | $3K | 2.08% |
| USI INSURANCE SERVICES LLC3 | 555 PLEASANTVILLE ROAD BRIARCLIFF MANOR, NY 10510 | STANDARD INSURANCE COMPANY | $0 | $2K | $2K | 1.27% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 825 NE MULTNOMAH STREET, SUITE 1500 PORTLAND, OR 97232 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.21% |
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 | 769 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 770 | 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 | 670 | $4.7M |
| Dental(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 670 | $4.7M |
| Vision | VISION SERVICE PLAN | 226 | $23K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 769 | $240K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 769 | $240K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 769 | $240K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 670 | $4.7M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 910 | $269K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 910 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.