| 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. | $158K | — | $158K | 1.84% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | $9K | $18K | 7.55% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 261 MADISON AVENUE, 5TH FLOOR NEW YORK, NY 10016 | SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK | $5K | — | $5K | 6.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, INC. | 261 MADISON AVE. 5TH FL NEW YORK, NY 10016 | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S.) | $2K | — | $2K | 5.29% |
| DENNIS FENNELL3 | 8 BELVOIR DRIVE WASHINGTONVILLE, NY 10992 | AFLAC | $188 | — | $188 | 10.01% |
| USI INSURANCE SERVICES LLC3 | 261 MADISON AVE FL 5 NEW YORK, NY 10016 | AFLAC | $126 | — | $126 | 6.71% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK STE 400 FAIRPORT, NY 14450 | AFLAC | $123 | — | $123 | 6.55% |
| RICHARD WHELAN3 | 1462 SEQUOIA CIR TOMS RIVER, NJ 08753 | AFLAC | $40 | — | $40 | 2.13% |
| JEFF DALABA3 | 8500 GILLY FLOWER COURT BALDWINSVILLE, NY 13027 | AFLAC | $14 | — | $14 | 0.75% |
| DAVID A COLLISON3 | 46 JOHNSTONE LANE GEORGETOWN, SC 29440 | AFLAC | $13 | — | $13 | 0.69% |
| DAVID M COUGHLIN3 | 3681 STARBRIGHT LN LAS VEGAS, NV 89147 | AFLAC | $1 | — | $1 | 0.05% |
| DAVID WEINGARTNER3 Filed as: DAVID M WEINGARTNER | 15 DAVID DR JOHNSON CITY, NY 13790 | AFLAC | $1 | — | $1 | 0.05% |
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 | 863 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 870 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 2,433 | $8.6M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 797 | $233K |
| Vision | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S.) | 827 | $47K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,134 | $356K |
| Short-term disability | SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK | 1,134 | $76K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 2,433 | $8.6M |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 827 | $282K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,433 | — |
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.