| 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 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $183 | $183 | 0.24% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $483 | $483 | 0.94% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 200 LIBERTY STREET, 7TH FLOOR NEW YORK, NY 10281 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA | $2K | — | $2K | 25.00% |
| HELEN LOUISE LUDVIGSON4 | 3405 NW 122ND STREET VANCOUVER, WA 98685 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $96 | — | $96 | 8.37% |
| MARIA SCHWARTZ4 | 312 VIA PROMESA SAN CLEMENTE, CA 92673 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $56 | — | $56 | 4.88% |
| ADAM LUDVIGSON4 | 3405 NW 122ND STREET VANCOUVER, WA 98685 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $26 | — | $26 | 2.27% |
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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 220 | $2.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 383 | $218K |
| Vision | VISION SERVICE PLAN | 175 | $37K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 191 | $78K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 192 | $51K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 192 | $51K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 220 | $2.2M |
| Other(5 contracts, 5 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 192 | $141K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.