| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $3K | $3K | 0.02% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 4.77% |
| DAUGHERTY & COMPANY INS BROKERS INC3 Filed as: DAUGHERTY & CO. INS. BROKERS, INC. | 2495 WEST MARCH LANE, SUITE 200 STOCKTON, CA 95207 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $41 | $0 | $41 | 0.07% |
| USI INSURANCE SERVICES LLC3 | 3247 WEST MARCH LANE, SUITE 210 STOCKTON, CA 95219 | SYMETRA LIFE INSURANCE COMPANY | $10K | $0 | $10K | 17.27% |
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 | 1,538 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 182 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,720 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 2,383 | $13.1M |
| Dental | DELTA DENTAL OF CALIFORNIA | 341 | $58K |
| Life insurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 2,280 | $745K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 2,280 | $688K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 2,383 | $13.5M |
| Other(2 contracts) | SYMETRA LIFE INSURANCE COMPANY | 2,280 | $744K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,383 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.