| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | P O BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $811 | $2 | $813 | 2.48% |
| USI INSURANCE SERVICES LLC3 | P O BOX 61187 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF CALIFORNIA | $57 | — | $57 | 10.04% |
| USI INSURANCE SERVICES LLC3 | P O BOX 61187 VIRGINIA BEACH, VA 23466 | CYPRESS DENTAL ADMINISTRATORS | $5 | — | $5 | 8.47% |
| USI INSURANCE SERVICES LLC | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER PERMANENTE | $0 | — | $0 | — |
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 | 3 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 3 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 3 | $33K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 1 | $627 |
| Vision | CYPRESS DENTAL ADMINISTRATORS | 0 | $59 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.