| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM BLUE CROSS AND BLUE SHIELD | $88K | $0 | $88K | 2.31% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 5200 NORTH PALM AVENUE, SUITE 114 FRESNO, CA 93704 | ANTHEM BLUE CROSS AND BLUE SHIELD | $0 | $31K | $31K | 0.82% |
| CARMEN L. MATOS REYES3 | UNKNOWN BRENTWOOD, NY 11717 | TRIPLE S SALUD, INC. | $5K | $0 | $5K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $907 | $450 | $1K | 18.82% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM BLUE CROSS | $301 | $0 | $301 | 12.60% |
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 | 170 | 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) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS AND BLUE SHIELD | 294 | $3.9M |
| Dental(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 14 | $108K |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 350 | $10K |
| Prescription drug(2 contracts, 2 carriers) | ANTHEM BLUE CROSS AND BLUE SHIELD | 294 | $3.9M |
| Other(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 350 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 350 | — |
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.