| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $82K | $0 | $82K | 2.89% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $9K | $0 | $9K | 3.16% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD AND BROWN INS. ADMINISTRATORS | 721 SOUTH PARKER STREET ORANGE, CA 92868 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $0 | $5K | $5K | 1.58% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $7K | $0 | $7K | 8.80% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $5K | $0 | $5K | 6.20% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.41% |
| N-GAGE LLC3 | 1999 PINE CREST ROAD GREEN BAY, WI 54313 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 21.58% |
| USI INSURANCE SERVICES LLC3 | 1001 GALAXY WAY, SUITE 300 CONCORD, CA 94520 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 9.25% |
| UNKNOWN3 | UNKNOWN HAYWARD, CA 94545 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $774 | $774 | 2.67% |
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 | 254 | 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) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 398 | $3.1M |
| Vision | VISION SERVICE PLAN | 156 | $31K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 249 | $80K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 249 | $80K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 398 | $3.1M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 249 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 398 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.