| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 10940 WHITE ROCK ROAD 2ND FLOOR RANCHO CORDOVA, CA 95670 | CALIFORNIA PHYSICIANS' SERVICE | $36K | $835 | $37K | 4.09% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 600 HIGHWAY 169 SOUTH FL 12 SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 3.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 21250 HAWTHORNE BLVD SUITE 600 TORRANCE, CA 90503 | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 2.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21250 HAWTHORNE BLVD SUITE 600 TORRANCE, CA 90503 | DELTA DENTAL OF CALIFORNIA | $656 | — | $656 | 1.05% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 39000 SAN FRANCISCO, CA 94139 | VISION SERVICE PLAN | $1K | — | $1K | 5.60% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 21250 HAWTHORNE BLVD SUITE 600 TORRANCE, CA 90503 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 10.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 10 SOUTH WACKER DRIVE FLOOR 17 CHICAGO, IL 60606 | HARTFORD LIFE AND ACCIDENT | — | $329 | $329 | 1.76% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 21250 HAWTHORNE BLVD SUITE 600 TORRANCE, CA 90503 | DELTA DENTAL OF CALIFORNIA | $307 | — | $307 | 2.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21250 HAWTHORNE BLVD SUITE 600 TORRANCE, CA 90503 | DELTA DENTAL OF CALIFORNIA | $114 | — | $114 | 1.08% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1300 SW 5TH AVE SUITE 500 PORTLAND, OR 97201 | HARTFORD LIFE AND ACCIDENT | $25 | — | $25 | 10.12% |
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 194 | $1.2M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 110 | $73K |
| Vision | VISION SERVICE PLAN | 100 | $19K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 0 | $19K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 0 | $19K |
| Other(2 contracts) | HARTFORD LIFE AND ACCIDENT | 0 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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.