| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | BLUE CROSS BLUE SHIELD ILLINOIS | $30K | $0 | $30K | 4.08% |
| BAUGHMAN GROUP3 Filed as: BAUGHMAN GROUP, INC. | UNKNOWN BELLEVUE, WA 98004 | BLUE CROSS BLUE SHIELD ILLINOIS | $4K | $0 | $4K | 0.48% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | HEALTH PARTNERS, INC. | $7K | $10 | $7K | 3.15% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | DELTA DENTAL OF WASHINGTON | $16K | $0 | $16K | 8.00% |
| MEDLINK INC3 Filed as: MEDLINK INC. | 2001 LAKE POINT WAY LOUISVILLE, KY 40223 | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | $4K | $196 | $4K | 2.05% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $19K | $2K | $20K | 11.53% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, ID 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $157 | $157 | 0.09% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NORTHWEST | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | VISION SERVICE PLAN | $2K | $0 | $2K | 4.17% |
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 | 428 | 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) | 428 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD ILLINOIS | 73 | $1.1M |
| Dental | DELTA DENTAL OF WASHINGTON | 495 | $197K |
| Vision | VISION SERVICE PLAN | 254 | $38K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 428 | $177K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 428 | $177K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 428 | $177K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD ILLINOIS | 73 | $1.1M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 428 | $177K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 495 | — |
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.