| 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 | $50K | — | $50K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $17K | — | $17K | 7.00% |
| USI INSURANCE SERVICES LLC | PO BOX 62939 NE VIRGINIA BEACH, VA 23466 | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | $8K | — | $8K | 5.51% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHEAST INC | 333 WESTCHESTER AVE WEST HARRISON, NY 106042910 | DELTA DENTAL OF NEW YORK | — | — | $0 | 0.00% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 3.96% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHEAST INC | 333 WESTCHESTER AVE WEST HARRISON, NY 106042910 | AETNA LIFE INSURANCE COMPANY | $6K | — | $6K | 10.66% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC. EIN 27-7391136 STOP LOSS COVERAGE | Insurance services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | P.O. BOX 11532A NEW YORK, NY 10286 | $1.2M |
| WEISERMAZARS LLP EIN 13-1459550 AUDITORS | Accounting (including auditing) Service code 10 | 135 W 50TH STREET SUITE 12 NEW YORK, NY 10020 | $40K |
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 | 1,797 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 49 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,846 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 9 | $54K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF NEW YORK | 1,433 | $1.7M |
| Vision(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 1,459 | $195K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 2,251 | $500K |
| Short-term disability(2 contracts, 2 carriers) | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,508 | $175K |
| Long-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,270 | $274K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 3,760 | $2.2M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 2,251 | $500K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,760 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.