| 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 | $71K | — | $71K | 3.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62683 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $50K | — | $50K | 2.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $33K | — | $33K | 3.87% |
| ISM INSURANCE INC3 Filed as: ISM INSURANCE, INC. | 1316 NORTH UNION STREET WILMINGTON, DE 19806 | ANTHEM HEALTH PLANS, INC. | $7K | — | $7K | 2.69% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | UNITED CONCORDIA INSURANCE COMPANY | $7K | — | $7K | 10.50% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | UNKNOWN VIRGINIA BEACH, VA 23466 | UNITED CONCORDIA INSURANCE COMPANY | $7K | — | $7K | 10.50% |
| 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. | $2K | — | $2K | 7.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 45 RIVER PARK PLACE WEST, SUITE 605 FRESNO, CA 93720 | ANTHEM LIFE INSURANCE COMPANY | $772 | — | $772 | 11.90% |
| ISM INSURANCE INC3 Filed as: ISM INSURANCE, INC. | 1316 NORTH UNION STREET WILMINGTON, DE 19806 | ANTHEM LIFE INSURANCE COMPANY | $17 | — | $17 | 0.26% |
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 | 252 | 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) | 252 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 462 | $3.5M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 404 | $99K |
| Vision | BLUE CROSS OF CALIFORNIA | 462 | $2.4M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 462 | $2.4M |
| Long-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 462 | $2.4M |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 462 | $3.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 462 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.