| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | BLUE CROSS OF CALIFORNIA | $23K | — | $23K | 2.74% |
| ARROYO INSURANCE SERVICES, INC.3 | 13749 RIVERSIDE DRIVE, SUITE 204 SHERMAN OAKS, CA 91423 | BLUE CROSS OF CALIFORNIA | $23K | — | $23K | 2.69% |
| ARROYO INSURANCE SERVICES, INC.3 | PO BOX 55248 SHERMAN OAKS, CA 91413 | KAISER FOUNDATION HEALTH PLAN INC | $22K | — | $22K | 2.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, SUITE 830 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC | $16K | — | $16K | 2.11% |
| ARROYO INSURANCE SERVICES, INC.3 | 13749 RIVERSIDE DRIVE, SUITE 204 SHERMAN OAKS, CA 91413 | UNITED CONCORDIA INSURANCE COMPANY | $7K | — | $7K | 5.78% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | UNITED CONCORDIA INSURANCE COMPANY | $5K | — | $5K | 4.23% |
| ARROYO INSURANCE SERVICES, INC.3 | 13749 RIVERSIDE DRIVE, SUITE 204 SHERMAN OAKS, CA 91413 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 6.94% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23510 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 5.32% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 290 TECHNOLOGY DRIVE, SUITE 100 IRVINE, CA 91367 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $2K | — | $2K | 2.09% |
| ARROYO INSURANCE SERVICES, INC.3 | 13749 RIVERSIDE DRIVE, SUITE 204 SHERMAN OAKS, CA 91413 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $844 | — | $844 | 5.74% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $628 | — | $628 | 4.27% |
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 | 216 | 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) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 158 | $1.7M |
| Dental(3 contracts, 3 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 252 | $239K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 252 | $106K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 252 | $106K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 252 | $106K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 252 | $106K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 158 | $1.7M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 252 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 252 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.