| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | UNKNOWN NEW YORK, NY 10018 | EMBLEM HEALTH | $159K | — | $159K | 3.99% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | HORIZON HEALTHCARE OF NEW JERSEY, INC. | $13K | — | $13K | 1.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 2400 EAST COMMERCIAL BOULEVARD SUITE 600 FORT LAUDERDALE, FL 33308 | HARTFORD LIFE INSURANCE COMPANY | $7K | — | $7K | 1.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 470 PARK AVENUE SOUTH, 6TH FLOOR NEW YORK, NY 10016 | HARTFORD LIFE INSURANCE COMPANY | — | $3K | $3K | 0.72% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 201 ALHOMBRO CIRCLE, SUITE 1000 CORAL GABLES, FL 33134 | HARTFORD LIFE INSURANCE COMPANY | $586 | — | $586 | 0.14% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 2400 EAST COMMERCIAL BOULEVARD SUITE 600 FORT LAUDERDALE, FL 33308 | KAISER FOUNDATION HEALTH PLAN, INC. | $6K | — | $6K | 1.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | HORIZON HEALTHCARE SERVICES, INC. | $4K | — | $4K | 1.73% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1715 NORTH WEST SHORE BOULEVARD SUITE 700 TAMPA, FL 33607 | VISION SERVICE PLAN | $1K | — | $1K | 1.75% |
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 | 1,600 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,600 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | EMBLEM HEALTH | 653 | $5.2M |
| Vision | VISION SERVICE PLAN | 536 | $71K |
| Life insurance | HARTFORD LIFE INSURANCE COMPANY | 1,183 | $420K |
| Long-term disability | HARTFORD LIFE INSURANCE COMPANY | 1,183 | $420K |
| Prescription drug(4 contracts, 4 carriers) | EMBLEM HEALTH | 653 | $5.2M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 1,600 | $456K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,600 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.