| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI CALIFORNIA INS SERVICES LLC | 630 GERMANTOWN PIKE, SUITE 200 PLYMOUTH MEETING, PA 19462 | CALIFORNIA PHYSICIANS SERVICE | $43 | $50K | $50K | 3.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | CALIFORNIA PHYSICIANS SERVICE | $29 | $36K | $36K | 2.27% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $641 | $9K | 10.75% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 20.00% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 905035519 | FIDELITY SECURITY LIFE INSURANCE CO. (EYEMED VISION CARE) | $2K | — | $2K | 9.92% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $152 | $1K | 12.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | ALISO VIEJO TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $96 | — | $96 | 0.96% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $119 | $2K | 19.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | ALISO VIEJO TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $85 | — | $85 | 0.93% |
| TRACY BROUGHTON4 | 6 EDENDALE STREET LADERA RANCH, CA 92694 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $246 | — | $246 | 10.03% |
| SHELTER MINISTRIES, INC.4 | 430 COURFIELD DRIVE FRANKLIN, TN 37064 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $92 | — | $92 | 3.75% |
| BLAKE HENRY4 | 9 SUMMITCREST TRABUCO CANYON, CA 92679 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $31 | — | $31 | 1.26% |
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 | 175 | 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) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 312 | $1.6M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 159 | $118K |
| Vision | FIDELITY SECURITY LIFE INSURANCE CO. (EYEMED VISION CARE) | 348 | $21K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 178 | $85K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 178 | $95K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 178 | $85K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 312 | $1.6M |
| Other(5 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 178 | $136K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 348 | — |
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.