| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 959 SKYWAY ROAD 2ND FLOOR SAN CARLOS, CA 94070 | BLUE CROSS OF CALIFORNIA | $138K | $0 | $138K | 3.15% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 203417 DALLAS, TX 75320 | BLUE CROSS OF CALIFORNIA | $0 | $5K | $5K | 0.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 39000 SAN FRANCISCO, CA 94139 | BLUE CROSS OF CALIFORNIA | $0 | $3K | $3K | 0.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 600 HIGHWAY 169 SOUTH 12TH FLOOR SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN, INC. | $19K | $0 | $19K | 0.90% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | $0 | $2K | 0.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 39000 SAN FRANCISCO, CA 94139 | VISION SERVICE PLAN | $3K | $0 | $3K | 2.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 959 SKYWAY ROAD SUITE 200 SAN CARLOS, CA 94070 | VISION SERVICE PLAN | $136 | $0 | $136 | 0.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10940 WHITE ROCK ROAD 2ND FLOOR RANCHO CORDOVA, CA 95670 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $371 | $0 | $371 | 3.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA | $2K | $0 | $2K | 15.00% |
| HECTOR MATHA4 | 40754 FLYING SEA ROAD PALM DESERT, CA 92211 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $824 | $0 | $824 | 7.31% |
| VINCENT P. FERANDA, IV4 Filed as: VINCENT P FERANDA IV | 774 VANDAL WAY PALMDALE, CA 93551 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $584 | $0 | $584 | 5.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | UNKNOWN SAN JOSE, CA 95138 | DELTA DENTAL OF CALIFORNIA | $397 | $0 | $397 | 3.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | UNKNOWN SAN JOSE, CA 95138 | DELTA DENTAL OF CALIFORNIA | $115 | $0 | $115 | 1.12% |
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 | 340 | 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) | 340 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 523 | $6.5M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 824 | $621K |
| Vision | VISION SERVICE PLAN | 324 | $113K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 523 | $4.4M |
| Short-term disability | BLUE CROSS OF CALIFORNIA | 523 | $4.4M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 523 | $4.4M |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 523 | $6.5M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 523 | $4.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 824 | — |
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.