| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $82K | $0 | $82K | 3.43% |
| EMERSON REID LLC3 Filed as: EMERSON REID AND COMPANY, INC. | 1305 WALT WHITMAN ROAD, SUITE 310 MELVILLE, NY 11747 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $23K | $0 | $23K | 0.95% |
| CARMEN L. MATOS REYES3 | UNKNOWN BRENTWOOD, NY 11717 | TRIPLE S SALUD, INC. | $4K | $0 | $4K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $1K | $0 | $1K | 15.93% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $0 | $259 | $259 | 2.87% |
| MICHAEL FALCON3 | 1721 NW 84TH DRIVE CORAL SPRINGS, FL 33071 | SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION | $222 | $0 | $222 | 28.50% |
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 | 322 | 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) | 322 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 338 | $2.5M |
| Dental(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 13 | $77K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 338 | $2.4M |
| Life insurance | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | 322 | $9K |
| Prescription drug(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 338 | $2.5M |
| Other(2 contracts, 2 carriers) | TRIPLE S SALUD, INC. | 322 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 338 | — |
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.