| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | CALIFORNIA PHYSICIANS SERVICE | $11K | $39K | $51K | 5.90% |
| USI INSURANCE SERVICES LLC3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $11K | $0 | $11K | 4.99% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $63 | $63 | 0.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | $46 | $2K | 5.15% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 16.14% |
| USI INSURANCE SERVICES LLC3 | 3247 WEST MARCH LANE, SUITE 210 STOCKTON, CA 95219 | AFLAC | $343 | $0 | $343 | 2.57% |
| MJ INSURANCE3 Filed as: VINCENT VOLLMAR AND VARIOUS AGENTS | 777 COMMERCIAL STREET SE, SUITE 20 SALEM, OR 97301 | AFLAC | $229 | $6 | $235 | 1.76% |
| BETH A. HESTER3 | 1143 CHAMPAGNE LANE MANTECA, CA 95337 | AFLAC | $185 | $0 | $185 | 1.39% |
| MARJORIE B. YACOPETTI3 | PO BOX 2152 LODI, CA 95241 | AFLAC | $163 | $7 | $170 | 1.27% |
| TREVOR WILKS3 | 722 HIGHLAND AVENUE NE SALEM, OR 97301 | AFLAC | $112 | $0 | $112 | 0.84% |
| CHERYL L. BONNER3 | 2754 TANGENT WAY SE SALEM, OR 97317 | AFLAC | $106 | $6 | $112 | 0.84% |
| SERAPIO M. NAMBO3 | 2175 57TH AVENUE SACRAMENTO, CA 95822 | AFLAC | $96 | $2 | $98 | 0.73% |
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 | 215 | 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) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS SERVICE | 184 | $1.1M |
| Dental | CALIFORNIA PHYSICIANS SERVICE | 184 | $858K |
| Vision | CALIFORNIA PHYSICIANS SERVICE | 184 | $858K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $30K |
| Prescription drug(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS SERVICE | 184 | $1.1M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.