| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 75 JOHN ROBERTS ROAD SOUTH PORTLAND, ME 04106 | AETNA LIFE INSURANCE COMPANY | $170K | $0 | $170K | 1.62% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN SALEM, MA 01970 | AETNA LIFE INSURANCE COMPANY | $0 | $134 | $134 | 0.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | $8K | $25K | 10.10% |
| USI INSURANCE SERVICES LLC3 | 12 GILL STREET, SUITE 5500 WOBURN, MA 01801 | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. | $2K | $0 | $2K | 2.57% |
| USI INSURANCE SERVICES LLC3 | 12 GILL STREET, SUITE 5500 WOBURN, MA 01801 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 15.00% |
| USI INSURANCE SERVICES LLC3 | 12 GILL STREET, SUITE 5500 WOBURN, MA 01801 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $14 | $3K | 23.19% |
| USI INSURANCE SERVICES LLC3 | 855 BOYLSTON STREET, 8TH FLOOR BOSTON, MA 02116 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $237 | $237 | 1.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 470 ATLANTIC AVENUE, 13TH FLOOR BOSTON, MA 02210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $73 | $0 | $73 | 0.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $61 | $0 | $61 | 0.47% |
| USI INSURANCE SERVICES LLC3 | 711 EAST MAIN STREET, SUITE 201 CHICOPEE, MA 01020 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA | $311 | $0 | $311 | 15.00% |
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 | 600 | 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) | 600 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,017 | $10.5M |
| Dental | AETNA LIFE INSURANCE COMPANY | 1,017 | $10.5M |
| Vision | AETNA LIFE INSURANCE COMPANY | 1,017 | $10.5M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 600 | $245K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 600 | $245K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,017 | $10.5M |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 600 | $281K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,017 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.