| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62939 VIRGINIA BEACH, VA 23466 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $80K | — | $80K | 3.35% |
| EMERSON REID LLC3 Filed as: EMERSON REID AND COMPANY, INC. | 1305 WALT WHITMAN ROAD SUITE 310 MELVILLE, NY 11747 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $33K | — | $33K | 1.37% |
| CARMEN L. MATOS REYES3 | UNKNOWN BRENTWOOD, NY 11717 | TRIPLE S SALUD, INC. | $3K | — | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $968 | $381 | $1K | 18.12% |
| MICHAEL FALCON3 | 1721 NW 84TH DRIVE CORAL SPRINGS, FL 33071 | SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION | $166 | — | $166 | 21.73% |
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 | 206 | 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) | 206 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 206 | $2.5M |
| Dental(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 13 | $60K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 206 | $2.4M |
| Life insurance | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | 206 | $7K |
| Prescription drug(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 206 | $2.5M |
| Other(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 206 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 206 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.