| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES OF RI INC | 475 KILVERT STREET WARWICK, RI 02904 | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | $2K | $42K | $44K | 1.50% |
| USI INSURANCE SERVICES LLC3 | 12 GILL STREET, SUITE 5500 WOBURN, MA 01801 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | $20K | $10K | $30K | 18.91% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.69% |
| AGIS NETWORK INSURANCE SERVICE3 | ONE BEACON STREET BOSTON, MA 02108 | LIFESECURE INSURANCE COMPANY | $731 | $0 | $731 | 6.06% |
| ADVANCED LTC INSURANCE SERVICES3 | PO BOX 261456 ENCINO, CA 91426 | LIFESECURE INSURANCE COMPANY | $328 | $0 | $328 | 2.72% |
| KARI HAWKINSON3 | 121 EAST CONSTELLATION SOUTH PADRE ISLAND, TX 78597 | LIFESECURE INSURANCE COMPANY | $154 | $0 | $154 | 1.28% |
| UNITED SERVICES OF AMERICA INS3 | PO BOX 6190 SAN DEIGO, CA 92166 | LIFESECURE INSURANCE COMPANY | $4 | $0 | $4 | 0.03% |
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 | 208 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 221 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 293 | $2.9M |
| Vision | VISION SERVICE PLAN | 153 | $30K |
| Life insurance | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 208 | $156K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 208 | $156K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 293 | $2.9M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 208 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 293 | — |
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.