| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 261 MADISON AVE FL 6 NEW YORK, NY 10016 | UNITED HEALTHCARE INSURANCE COMPANY (4A HEALTH) | $47K | — | $47K | 1.89% |
| USI INSURANCE SERVICES LLC3 | P O BOX 3716 NORFOLK, VA 23514 | METROPOLITAN LIFE INSURANCE COMPANY (4D DENTAL HMO) | $8K | $6K | $14K | 3.92% |
| STOCKBRIDGE RESOURCES INC.3 Filed as: STOCKBRIDGE RESOURCES INC | 40 CUTTERMILL ROAD STE 405 GREAT NECK, NY 11021 | SUN LIFE AND HEALTH INSURANCE CO US (4B 4F 4H) | $11K | — | $11K | 9.02% |
| USI INSURANCE SERVICES LLC3 | P O BOX 3716 NORFOLK, VA 235143716 | SAFEGUARD HEALTH PLANS INC A FLORIDA CORPORATION (4D DENTAL HMO) | $160 | $30 | $190 | 11.93% |
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 | 238 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY (4A HEALTH) | 238 | $2.5M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY (4D DENTAL HMO) | 1,170 | $356K |
| Life insurance | SUN LIFE AND HEALTH INSURANCE CO US (4B 4F 4H) | 161 | $117K |
| Short-term disability | SUN LIFE AND HEALTH INSURANCE CO US (4B 4F 4H) | 161 | $117K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE CO US (4B 4F 4H) | 161 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,170 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.