| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | 711 EAST MAIN STREET, SUITE 201 CHICOPEE, MA 01020 | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | $199K | $31K | $230K | 2.90% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $0 | $13K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | 711 EAST MAIN STREET, SUITE 201 CHICOPEE, MA 01020 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $0 | $9K | 9.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | 711 EAST MAIN STREET, SUITE 201 CHICOPEE, MA 01020 | ESI EMPLOYEE ASSISTANCE GROUP | $829 | $0 | $829 | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | 711 EAST MAIN STREET, SUITE 201 CHICOPEE, MA 01020 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PA | $371 | $0 | $371 | 15.02% |
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 | 691 | 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) | 691 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 1,287 | $7.9M |
| Dental | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 1,287 | $7.9M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 691 | $100K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 691 | $130K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | 1,287 | $7.9M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 691 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,287 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.