| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $50K | $2K | $52K | 3.36% |
| CORPORATE SYNERGIES GROUP LLC3 | THE FERRY TERMINAL BUILDING CEMDEN, NJ 08103 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $133 | $0 | $133 | 0.01% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $1K | $0 | $1K | 3.15% |
| CLEARCHOICE BENEFITS AGENCY LLC3 | 13 SOUTH 24TH STREET WYANDANCH, NY 11798 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $992 | $0 | $992 | 2.55% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS INC. | 225 WIRELESS BOULEVARD HAUPPAUGE, NY 11788 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $160 | $0 | $160 | 0.41% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | FSL NY | $348 | $0 | $348 | 5.00% |
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 | 165 | 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) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 148 | $1.6M |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 148 | $1.6M |
| Vision(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 148 | $1.6M |
| Life insurance | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | 165 | $39K |
| Long-term disability | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | 165 | $39K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 148 | $1.6M |
| Other | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | 165 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.