| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNKNOWN3 | UNKNOWN NEW YORK, NY 10018 | EMBLEM HEALTH | $69K | — | $69K | 1.72% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | HORIZON HEALTHCARE OF NEW JERSEY, INC. | $9K | — | $9K | 1.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 100 NORTHEAST 3RD AVENUE, SUITE 610 FORT LAUDERDALE, FL 33301 | AETNA LIFE INSURANCE COMPANY | — | $46 | $46 | 0.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 470 PARK AVENUE SOUTH, 6TH FLOOR NEW YORK, NY 10016 | HARTFORD LIFE INSURANCE COMPANY | — | $5K | $5K | 1.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62689 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE INSURANCE COMPANY | $5K | — | $5K | 1.60% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 201 ALHOMBRO CIRCLE, SUITE 1000 CORAL GABLES, FL 33134 | HARTFORD LIFE INSURANCE COMPANY | $485 | — | $485 | 0.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $5K | — | $5K | 1.73% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | HORIZON HEALTHCARE SERVICES, INC. | $4K | — | $4K | 1.70% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62689 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $9K | — | $9K | 5.81% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 470 PARK AVENUE SOUTH, 6TH FLOOR NEW YORK, NY 10016 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 1.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF FLORIDA, INC | 1450 BRICKELL AVENUE, SUITE 1600 MIAMI, FL 33131 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 0.98% |
| CAPITAL CITY INSURANCE AGENCY LLC3 Filed as: CAPITAL CITY INSURANCE AGENCY, LLC | 370 ATWOOD AVENUE CRANSTON, RI 02920 | UNITEDHEALTHCARE INSURANCE COMPANY | $1K | $209 | $2K | 1.88% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | VISION SERVICE PLAN | $413 | — | $413 | 0.57% |
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 | 1,182 | 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) | 1,182 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | EMBLEM HEALTH | 643 | $4.9M |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 2,034 | $426K |
| Vision | VISION SERVICE PLAN | 518 | $72K |
| Life insurance | HARTFORD LIFE INSURANCE COMPANY | 1,182 | $311K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 457 | $159K |
| Long-term disability | HARTFORD LIFE INSURANCE COMPANY | 1,182 | $311K |
| Prescription drug(4 contracts, 4 carriers) | EMBLEM HEALTH | 643 | $4.6M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 1,182 | $318K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,034 | — |
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."
No prospect flags tripped on this filing.