| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | DELTA DENTAL OF CALIFORNIA | $13K | — | $13K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $906 | $3K | 7.07% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST | 700 NE MULTNOMAH, SUITE 1300 PORTLAND, OR 97232 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $217 | — | $217 | 2.40% |
| MICHAEL KIRKPATRICK3 | PO BOX 270 FREEDOM, CA 95050 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $137 | $1 | $138 | 1.53% |
| MICHAEL JAMES LEBRANE3 | 808 EAST 5TH AVENUE SAN MATEO, CA 94402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $97 | $3 | $100 | 1.11% |
| ZANA KIRKPATRICK3 Filed as: ZANA C. KIRKPATRICK | 1400 COLEMAN AVENUE SANTA CLARA, CA 95050 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $50 | — | $50 | 0.55% |
| MJ INSURANCE3 Filed as: ZINA OSTER AND VARIOUS AGENTS | 3153 FOREST DRIVE CHEYENNE, WY 82001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $45 | $4 | $49 | 0.54% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS, INC. | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $12 | $44 | 0.49% |
| MARK TETSUO IWASAKI3 Filed as: MARK TETSOU IWASAKI | 133 CRABAPPLE COURT HERCULES, CA 94547 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.41% |
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 | 271 | 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) | 271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 285 | $1.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 420 | $268K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 271 | $41K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 285 | $1.7M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 271 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 420 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.