| 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 | $74K | $0 | $74K | 3.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2121 NORTH CALIFORNIA BOULEVARD SUITE 350 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC | $5K | $0 | $5K | 0.24% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, SUITE 1100 SAN FRANCISCO, CA 94105 | SUTTER HEALTH PLAN | $10K | $0 | $10K | 5.42% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $15K | $0 | $15K | 18.78% |
| USI INSURANCE SERVICES LLC3 | 3805 WEST CHESTER PIKE, SUITE 200 NEWTOWN SQUARE, PA 19073 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $4K | $4K | 4.74% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $994 | $0 | $994 | 5.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | -$50 | $0 | -$50 | -0.30% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | LEGALPLANS USA | $371 | $0 | $371 | 14.98% |
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 | 308 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 310 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 244 | $2.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 315 | $131K |
| Vision | VISION SERVICE PLAN | 141 | $17K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 338 | $80K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 338 | $80K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 244 | $2.4M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 338 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 338 | — |
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.