| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $53K | $0 | $53K | 3.99% |
| USI INSURANCE SERVICES LLC3 | 6100 FAIRVIEW ROAD, SUITE 1400 14TH FLOOR CHARLOTTE, NC 28210 | BLUE CROSS OF CALIFORNIA | $0 | $3K | $3K | 0.19% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $2K | $10K | 6.19% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $3K | $0 | $3K | 3.53% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $2K | $0 | $2K | 4.75% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $510 | $132 | $642 | 6.44% |
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 | 248 | 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) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 248 | $1.6M |
| Dental(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 296 | $183K |
| Vision | BLUE CROSS OF CALIFORNIA | 248 | $1.3M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 248 | $1.3M |
| Prescription drug(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 248 | $1.6M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 248 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 296 | — |
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."
No prospect flags tripped on this filing.