| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $76K | $0 | $76K | 4.00% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, 37TH FLOOR SAN FRANCISCO, CA 94105 | SUTTER HEALTH PLAN | $27K | $0 | $27K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 1001 GALAXY WAY, SUITE 300 CONCORD, CA 94520 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $30K | $0 | $30K | 9.14% |
| UNKNOWN3 | UNKNOWN PLEASANTON, CA 94588 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $11K | $11K | 3.26% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 3.93% |
| INTEGRITY ASSET SERVICES LLC4 Filed as: INTEGRITY ASSET SERVICES, LLC | 1873 KOYUKON DRIVE SOUTH LAKE TAHOE, CA 96150 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $64 | $0 | $64 | 11.25% |
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 | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 230 | $2.4M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $330K |
| Vision | VISION SERVICE PLAN | 156 | $36K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $330K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $330K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $330K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 230 | $2.4M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $331K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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.