| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | SUTTER HEALTH PLAN | $66K | $0 | $66K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $0 | $12K | 1.83% |
| USI INSURANCE SERVICES LLC3 | 4605 COLUMBUS STREET VIRGINIA BEACH, VA 23462 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $4K | $13K | 14.10% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN VIRGINIA BEACH, VA 23466 | UNITED CONCORDIA INSURANCE COMPANY | $8K | $782 | $9K | 11.04% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $7 | $2K | 8.60% |
| LAURA RUNYEON3 | 2042 WEATHERBY WAY PETALUMA, CA 94954 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $589 | $357 | $946 | 3.83% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $564 | $0 | $564 | 2.28% |
| DARRYL W VIDOR3 Filed as: DARRYL W. VIDOR | 3314 EUROPA STREET ROSEVILLE, CA 95661 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $542 | $0 | $542 | 2.19% |
| GRAND GUILLORY3 | 5116 FURLONG WAY ANTIOCH, CA 94531 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $74 | $29 | $103 | 0.42% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS, LLC | 1151 SOUZA WAY FOLSOM, CA 95630 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $59 | $0 | $59 | 0.24% |
| MIKAELA MARIE WOOD3 | 1087 TWINBERRY STREET PLUMAS LAKE, CA 95961 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.02% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 9.94% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN VIRGINIA BEACH, VA 23466 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $2K | $172 | $2K | 10.19% |
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 | 261 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 270 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 253 | $2.0M |
| Dental(3 contracts, 3 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 155 | $121K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 233 | $22K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 261 | $118K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 261 | $118K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 261 | $93K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 253 | $2.0M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 261 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 261 | — |
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.