| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $103K | $2K | $105K | 5.12% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $24K | $0 | $24K | 15.61% |
| USI INSURANCE SERVICES LLC3 | 333 SOUTH GRAND AVENUE LOS ANGELES, CA 90071 | DELTA DENTAL OF CALIFORNIA | $12K | $0 | $12K | 10.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | $0 | $2K | 10.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $25 | $1K | 8.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $134 | $0 | $134 | 0.76% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $306 | $28 | $334 | 2.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $37 | $0 | $37 | 0.31% |
| TRACY BROUGHTON4 | 6 EDENDALE STREET LADERA RANCH, CA 92694 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $90 | $0 | $90 | 11.41% |
| BY HIS DESIGN, INC.4 | 430 COURFIELD DRIVE FRANKLIN, TN 37064 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $38 | $0 | $38 | 4.82% |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 206 | $2.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 347 | $123K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 330 | $22K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 205 | $157K |
| Short-term disability(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 205 | $169K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 205 | $157K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 206 | $2.0M |
| Other(5 contracts, 5 carriers) | BLUE CROSS OF CALIFORNIA | 206 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 347 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.