| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL,INC | 600 HIGHWAY 169 SOUTH ST LOUIS PARK, MN 55426 | AETNA LIFE INSURANCE CO | $40K | $2K | $42K | 5.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 180 PARK AVE 1ST FLOOR FLORHAM PARK, NJ 07932 | DELTA DENTAL OF NEW JERSEY, INC | $4K | $0 | $4K | 3.31% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DR BLOOMINGTON, MN 55437 | AETNA LIFE INSURANCE CO | $3K | $255 | $3K | 3.48% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 180 PARK AVENUE SUITE 102 FLORHAM PARK, NJ 07932 | SILVER SCRIPT - CVS PHARMACY, INC. | $0 | — | $0 | 0.00% |
| DAN MACLELLAN3 Filed as: DAN MCLELLAN | PO BOX 58434 NASHVILLE, TN 37205 | VISION SERVICE PLAN | $573 | — | $573 | 2.39% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62939 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $573 | — | $573 | 2.39% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL,INC | 180 PARK AVE 1ST FLOOR FLORHAM PARK, NJ 07932 | FLAGSHIP HEALTH SYSTEMS | $27 | $0 | $27 | 0.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $331K |
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 | 344 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 40 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 384 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 3 carriers) | DELTA DENTAL OF NEW JERSEY, INC | 285 | $233K |
| Vision | VISION SERVICE PLAN | 173 | $24K |
| Prescription drug(2 contracts, 2 carriers) | EXPRESS SCRIPTS | 308 | $2.7M |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE CO | 308 | $806K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 308 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.