| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $145K | $0 | $145K | 4.00% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | SUTTER HEALTH PLAN | $123K | $0 | $123K | 4.00% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | WESTERN HEALTH ADVANTAGE | $45K | $0 | $45K | 3.93% |
| USI INSURANCE SERVICES LLC3 | 333 SOUTH GRAND AVENUE, SUITE 1450 LOS ANGELES, CA 90071 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $63K | $0 | $63K | 11.08% |
| UNKNOWN3 | UNKNOWN ROSEVILLE, CA 95661 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $21K | $21K | 3.63% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $18K | $0 | $18K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | BLUE CROSS OF CALIFORNIA | $0 | $8K | $8K | 2.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $0 | $4K | 4.62% |
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 | 1,239 | 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) | 1,239 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 489 | $8.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,197 | $568K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 1,050 | $93K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,197 | $568K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,197 | $568K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,197 | $568K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 489 | $8.2M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,197 | $568K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,197 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.