| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1039-A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | BLUE CROSS BLUE SHIELD OF TEXAS | $72K | $3K | $75K | 2.54% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, 11TH FLOOR SAN FRANCISCO, CA 94105 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $25K | $0 | $25K | 4.38% |
| USI INSURANCE SERVICES LLC3 | 45 FREMONT STREET, SUITE 800 SAN FRANCISCO, CA 94105 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $0 | $5K | 0.92% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, SUITE 1100 SAN FRANCISCO, CA 94105 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $0 | $3K | 0.47% |
| USI INSURANCE SERVICES LLC3 | 1039 NORTH MCDOWELL BOULEVARD SUITE A PETALUMA, CA 94954 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 15.00% |
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 | 341 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 344 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF TEXAS | 601 | $2.9M |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 708 | $564K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 708 | $564K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 708 | $564K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 708 | $564K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF TEXAS | 601 | $2.9M |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 708 | $590K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 708 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.