| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $55K | — | $55K | 10.55% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $17K | — | $17K | 7.49% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 4.31% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | — | $6K | 10.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 62939 ATTN NORTHEAST VIRGINIA BEACH, VA 23466 | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | $2K | — | $2K | 4.01% |
| EMERSON REID LLC3 Filed as: EMERSON REID & COMPANY INC. | 1305 WALT WHITMAN RD SUITE 310 MELVILLE, NY 11747 | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | — | $1K | $1K | 2.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHEAST INC | 333 WESTCHESTER AVE WEST HARRISON, NY 106042910 | AETNA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.04% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 10.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC. EIN 27-7391136 ADMINISTRATOR | Other fees; Insurance services; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | P.O. BOX 11532A NEW YORK, NY 10286 | $2.9M |
| USI NORTHEAST EIN 13-1700680 BENEFIT CONSULTANT | Consulting fees; Consulting (general) Service code 16 | P.O. BOX 3716 NORFOLK, VA 23514 | $149K |
| WEISERMAZARS LLP EIN 13-1459550 AUDITORS | Accounting (including auditing) Service code 10 | 135 W 50TH STREET SUITE 12 NEW YORK, NY 10020 | $35K |
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 | 1,647 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 28 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,675 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 10 | $41K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF NEW YORK | 1,245 | $1.5M |
| Vision(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 1,313 | $89K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,143 | $521K |
| Short-term disability(2 contracts, 2 carriers) | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 529 | $156K |
| Long-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,047 | $252K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,143 | $521K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,313 | — |
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.