| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. - DALLAS TX | P.O. BOX 61187 VIRGINIA BEACH, VA 23466 | FIRST AMERICAN ADMINISTRATORS INC | $21K | — | $21K | 6.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. - DALLAS TX | P.O. BOX 61187 VIRGINIA BEACH, VA 23466 | FIRST AMERICAN ADMINISTRATORS INC | $85 | — | $85 | 5.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Float revenue; Claims processing; Participant communication; Other services; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Contract Administrator Service code 12 | — | $1.0M |
| EVERNORTH BEHAVIORAL HEALTH, INC. EIN 41-1648670 | Claims processing; Participant communication; Contract Administrator; Direct payment from the plan Service code 12 | — | $25K |
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 | 2,325 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,327 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC. | 62 | $596K |
| Vision(2 contracts) | FIRST AMERICAN ADMINISTRATORS INC | 2,110 | $339K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,327 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,327 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.