| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 470 PARK AVENUE SOUTH 6TH FLOOR NEW YORK, NY 10016 | AMERICAN GENERAL LIFE INSURANCE COMPANY | — | $21K | $21K | 3.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $18K | — | $18K | 4.09% |
| USI INSURANCE SERVICES LLC3 | 261 MADISON AVENUE 5TH FLOOR NEW YORK, NY 10016 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $11K | $11K | 2.64% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVENUE SUITE 102 WEST HARRISON, NY 10604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 0.31% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE O/B/O THE COMBINED INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 2.34% |
| USI INSURANCE SERVICES LLC3 | 261 MADISON AVENUE 5TH FLOOR NEW YORK, NY 10016 | ARCH INSURANCE COMPANY | — | $13K | $13K | 8.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE O/B/O THE COMBINED INSURANCE COMPANY OF AMERICA | $35 | — | $35 | 1.90% |
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 | 3,523 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 32 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,555 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 30 | $129K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,584 | $242K |
| Vision(2 contracts) | EYEMED VISION CARE O/B/O THE COMBINED INSURANCE COMPANY OF AMERICA | 5,931 | $200K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 3,610 | $710K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,600 | $431K |
| Other(2 contracts) | ARCH INSURANCE COMPANY | 3,436 | $163K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,931 | — |
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.