| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1039 NORTH MCDOWELL BOULEVARD SUITE A PETALUMA, CA 94954 | KAISER FOUNDATION HEALTH PLAN INC. | $22K | $0 | $22K | 3.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 1039A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | PREMIER ACCESS INSURANCE COMPANY | $6K | $0 | $6K | 8.09% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1039 A NORTH MCDOWELL PETALUMA, CA 94954 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | $0 | $1K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 45 FREMONT STREET, SUITE 800 SAN FRANCSISCO, CA 94105 | MANAGED HEALTH NETWORK | $374 | $0 | $374 | 3.79% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 601146 CHARLOTTE, NC 28260 | MANAGED HEALTH NETWORK | $120 | $0 | $120 | 1.22% |
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 | 213 | 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) | 213 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 93 | $636K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 172 | $77K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 213 | $12K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 213 | $12K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 93 | $636K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 215 | $22K |
| 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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.