| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | BLUE CROSS OF CALIFORNIA | $51K | $0 | $51K | 3.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 999 3RD AVENUE, SUITE 4100 SEATTLE, WA 98104 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $7K | $0 | $7K | 4.16% |
| USI INSURANCE SERVICES LLC3 | 999 3RD AVENUE, SUITE 4100 SEATTLE, WA 98104 | METROPOLITAN LIFE INSURANCE | $6K | $57 | $6K | 5.01% |
| USI INSURANCE SERVICES LLC3 | 1018 WEST 9TH AVENUE KING OF PRUSSIA, PA 19406 | METROPOLITAN LIFE INSURANCE | $0 | $2K | $2K | 1.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 999 3RD AVENUE, SUITE 4100 SEATTLE, WA 98104 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $2K | $0 | $2K | 3.44% |
| USI INSURANCE SERVICES LLC3 | 999 3RD AVENUE, SUITE 4100 SEATTLE, WA 98104 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $479 | $0 | $479 | 4.99% |
| USI INSURANCE SERVICES LLC3 | 1018 WEST 9TH AVENUE KING OF PRUSSIA, PA 19406 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $0 | $155 | $155 | 1.62% |
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 | 282 | 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) | 282 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 282 | $1.7M |
| Dental(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE | 389 | $148K |
| Vision | BLUE CROSS OF CALIFORNIA | 282 | $1.3M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 282 | $1.3M |
| Prescription drug(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 282 | $1.7M |
| Other | BLUE CROSS OF CALIFORNIA | 282 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 389 | — |
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.