| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC | 1039 NORTH MCDOWELL BOULEVARD SUITE A PETALUMA, CA 94954 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $18K | $0 | $18K | 9.93% |
| USI INSURANCE SERVICES LLC3 | 45 FREMONT STREET, SUITE 800 SAN FRANCISCO, CA 94105 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $326 | $326 | 0.18% |
| USI INSURANCE SERVICES LLC3 | 1039 NORTH MCDOWELL BOULEVARD SUITE A PETALUMA, CA 94954 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $0 | $9K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 1039A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.30% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, SUITE 1100 SAN FRANCISCO, CA 94105 | CLAREMONT EAP | $163 | $0 | $163 | 2.92% |
| USI INSURANCE SERVICES LLC3 | 1039 A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | CLAREMONT EAP | $116 | $0 | $116 | 2.08% |
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 | 136 | 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) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 150 | $186K |
| Vision | VISION SERVICE PLAN | 152 | $29K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $92K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $92K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $92K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.