| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $37K | — | $37K | 4.11% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 38 DISCOVERY, SUITE 250 IRVINE, CA 92618 | CALIFORNIACHOICE | $6K | — | $6K | 6.50% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | DENTAL HEALTH SERVICES | $6K | — | $6K | 10.00% |
| MCCAREY INC3 Filed as: MCCAREY, INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $782 | $258 | $1K | 3.45% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $711 | $23 | $734 | 2.44% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R AND B ENROLLMENT SERVICES | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $579 | $49 | $628 | 2.08% |
| ANDREA MARIE TIERCE3 Filed as: ANDREA MARIE TEIRCE | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $261 | $34 | $295 | 0.98% |
| VINCENT GERARD MCLAUGHLIN3 | 30310 HORSETHIEF DRIVE TEHACHAPI, CA 93561 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $103 | $56 | $159 | 0.53% |
| JOHN A. BRADLEY INC.3 Filed as: JOHN A. BRADLEY, INC. | 207 SOUTH MAIN STREET FOUNTAIN INN, SC 29644 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $153 | — | $153 | 0.51% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS. SVCS, LLC AND OTHER AGENTS | 2021 WEST MARCH LANE STOCKTON, CA 95207 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $124 | — | $124 | 0.41% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | VISION SERVICE PLAN | $1K | — | $1K | 5.18% |
| SANDRA R ROKOP3 Filed as: SANDRA ROKOP | 74 CONGRESS PLACE IRVINE, CA 92602 | AFLAC | $2K | $159 | $2K | 8.71% |
| DONALD F WASINGER3 Filed as: DONALD F. WASINGER | 74 CONGRESS PLACE IRVINE, CA 92602 | AFLAC | $731 | $32 | $763 | 3.89% |
| JANICE ADAMSON3 | 495 EAST RINCON STREET, SUITE 212 CORONA, CA 92879 | AFLAC | $223 | $32 | $255 | 1.30% |
| DANIEL TYLER ADAMSON3 Filed as: DANIEL ADAMSON | 2700 NORTH MAIN STREET, SUITE 601 SANTA ANA, CA 92705 | AFLAC | $118 | — | $118 | 0.60% |
| MJ INSURANCE3 Filed as: JAMES BOADA AND VARIOUS AGENTS | 5700 EAST FRANKLIN ROAD, SUITE 210 NAMPA, ID 83687 | AFLAC | $108 | — | $108 | 0.55% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE LUCZAJ | 255 EAST RINCON STREET, SUITE 110 CORONA, CA 92879 | AFLAC | $32 | — | $32 | 0.16% |
| G SCOTT COOKE3 Filed as: SCOTT BLACKSHEAR | 3453 CATHRYN DRIVE COLUMBUS, GA 31906 | AFLAC | $31 | — | $31 | 0.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $508 | $38 | $546 | 10.75% |
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 | 147 | 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) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 172 | $995K |
| Dental | DENTAL HEALTH SERVICES | 211 | $63K |
| Vision | VISION SERVICE PLAN | 149 | $23K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $5K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 147 | $25K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 172 | $995K |
| Other(4 contracts, 4 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 141 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.