| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | SUTTER HEALTH PLAN | $65K | $0 | $65K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $0 | $12K | 2.00% |
| USI INSURANCE SERVICES LLC3 | 4605 COLUMBUS STREET VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $3K | $10K | 12.02% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN VIRGINIA BEACH, VA 23466 | UNITED CONCORDIA INSURANCE COMPANY | $8K | $707 | $8K | 10.86% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $1 | $2K | 9.16% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $7 | $1K | 4.61% |
| DARRYL W VIDOR3 Filed as: DARRYL W. VIDOR | 3314 EUROPA STREET ROSEVILLE, CA 95661 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $591 | $0 | $591 | 2.40% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS, LLC | 1151 SOUZA WAY FOLSOM, CA 95630 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $58 | $0 | $58 | 0.24% |
| MARY KOCH3 | 2202 TAYSIDE XING NW KENNESAW, GA 30152 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $29 | $0 | $29 | 0.12% |
| JOSEPHINE EBALO BACCAY3 | 3812 AETNA SPRINGS WAY SACRAMENTO, CA 95834 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $1 | $27 | 0.11% |
| LAURA RUNYEON3 Filed as: LAURA RUNYEON AND OTHER AGENTS | 2042 WEATHERBY WAY PETALUMA, CA 94954 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $11 | $20 | 0.08% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.04% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN VIRGINIA BEACH, VA 23466 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $2K | $166 | $2K | 10.92% |
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 | 241 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 246 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 258 | $1.9M |
| Dental(3 contracts, 3 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 142 | $120K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 109 | $22K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 241 | $110K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 241 | $110K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 241 | $85K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 258 | $1.9M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 241 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 258 | — |
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."
No prospect flags tripped on this filing.