| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $108K | $0 | $108K | 3.98% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $0 | $188 | $188 | 0.01% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $10K | $2 | $10K | 2.55% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: WORD & BROWN INS. ADMIN., INC. | 721 SOUTH PARKER STREET ORANGE, CA 92868 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $0 | $5K | $5K | 1.27% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | UNITEDHEALTHCARE INSURANCE COMPANY | $5K | $0 | $5K | 4.30% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $20K | $0 | $20K | 17.44% |
| N-GAGE LLC3 Filed as: N-GAGE, LLC | 1999 PINE CREST ROAD GREEN BAY, WI 54313 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | $0 | $12K | 19.05% |
| USI INSURANCE SERVICES LLC3 | 1001 GALAXY WAY, SUITE 300 CONCORD, CA 94520 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 8.34% |
| UNKNOWN3 | UNKNOWN HAYWARD, CA 94545 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $658 | $658 | 1.09% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $2K | $0 | $2K | 4.36% |
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 | 282 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 373 | $3.2M |
| Vision | VISION SERVICE PLAN | 179 | $35K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 282 | $112K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 282 | $112K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 282 | $112K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 373 | $3.2M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 282 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 373 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.