| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 600 HIGHWAY 169 SOUTH, SUITE 1200 SAINT LOUIS PARK, MN 55426 | AETNA LIFE INSURANCE COMPANY | $43K | $339 | $44K | 4.11% |
| USI INSURANCE SERVICES LLC3 | 200 SUMITT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $264 | $0 | $264 | 5.72% |
| USI INSURANCE SERVICES LLC3 | 7 GIRALDA FARMS, 2ND FLOOR MADISON, NJ 07940 | FIRST UNUM LIFE INSURANCE COMPANY | $883 | $0 | $883 | 20.33% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $87 | $87 | 2.00% |
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 | 135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 135 | $1.1M |
| Dental | AETNA LIFE INSURANCE COMPANY | 135 | $1.1M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 61 | $5K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 135 | $1.1M |
| Short-term disability | AETNA LIFE INSURANCE COMPANY | 135 | $1.1M |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 135 | $1.1M |
| Prescription drug | AETNA LIFE INSURANCE COMPANY | 135 | $1.1M |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 135 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.