| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203373 DALLAS, TX 75320 | KAISER FOUNDATION HEALTH PLAN INC | $70K | $0 | $70K | 2.99% |
| USI INSURANCE SERVICES LLC3 | 525 MARKET STREET, SUITE 2200 SAN FRANCISCO, CA 94105 | UNITEDHEALTHCARE INSURANCE COMPANY | $57K | $0 | $57K | 3.53% |
| USI INSURANCE SERVICES LLC3 | 1039N MCDOWELL BOULEVARD PETALUMA, CA 94954 | DELTA DENTAL OF CALIFORNIA | $23K | $0 | $23K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 39000 SAN FRANCISCO, CA 94139 | VISION SERVICE PLAN | $3K | $0 | $3K | 2.50% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, 11TH FLOOR SAN FRANCISCO, CA 94105 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | $0 | $8K | 8.54% |
| USI INSURANCE SERVICES LLC3 | 2502 NORTH ROCKY POINT DRIVE SUITE 400 TAMPA, FL 33607 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $3K | $3K | 3.11% |
| USI INSURANCE SERVICES LLC3 | 45 FREMONT, SUITE 800 SAN FRANCISCO, CA 94105 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | $0 | $2K | 3.00% |
| USI INSURANCE SERVICES LLC3 | 45 FREMONT STREET, SUITE 800 SAN FRANCISCO, CA 94105 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $121 | $0 | $121 | 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 | 365 | 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) | 365 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 344 | $4.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 666 | $461K |
| Vision | VISION SERVICE PLAN | 351 | $108K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 353 | $95K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 353 | $95K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 353 | $95K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 344 | $4.0M |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 391 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 666 | — |
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.