| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 62939 VIRGINIA BEACH, VA 234662939 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $24 | $5K | 2.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 3716 NORFOLK, VA 235143716 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 1.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Direct payment from the plan Service code 12 | — | $3.5M |
| PETER J. RUFFNER EIN 13-6211854 | Employee (plan) Service code 30 | — | $96K |
| VITECH SYSTEMS GROUP EIN 13-3785492 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $60K |
| EXPRESS SCRIPTS, INC EIN 22-3461470 | Other fees; Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $55K |
| RITA MESSINA EIN 13-6211854 | Employee (plan) Service code 30 | — | $49K |
| ULLICO CASUALTY GROUP EIN 13-2988846 | Insurance services; Insurance brokerage commissions and fees; Direct payment from the plan Service code 23 | — | $47K |
| LOUISE FURIO EIN 13-6211854 | Employee (plan) Service code 30 | — | $46K |
| ROGER ROSS EIN 13-6211854 | Employee (plan) Service code 30 | — | $42K |
| KEVIN J. DRISCOLL EIN 13-6211854 | Employee (plan) Service code 30 | — | $36K |
| FRANCES MCCANN EIN 13-6211854 | Employee (plan) Service code 30 | — | $29K |
| LAPADULA, CARLSON & CO. CPA EIN 65-0292391 | Accounting (including auditing) Service code 10 | — | $28K |
| VIRGINIA & AMBINDER EIN 13-4166736 | Legal; Direct payment from the plan Service code 29 | — | $27K |
| STEIN & STEIN, ATTORNEYS AT LAW EIN 11-3229754 | Legal; Direct payment from the plan Service code 29 | — | $27K |
| WILLIAM J. TURNBULL EIN 13-6211854 | Employee (plan) Service code 30 | — | $26K |
| INTEGRITY PHARMACEUTICAL ADV. LLC EIN 45-3047652 | Actuarial Service code 11 | — | $24K |
| THE SEGAL COMPANY EIN 13-1835864 | Direct payment from the plan; Actuarial Service code 11 | — | $19K |
| SEGAL ADVISORS EIN 13-2646110 | Consulting fees; Investment management fees paid directly by plan; Investment advisory (plan) Service code 27 | — | $15K |
| ALAIN J. DERZIE EIN 11-8645131 | Other services Service code 49 | — | $14K |
| RICHARD S. BROOK, ESQ. EIN 11-2543273 | Legal; Direct payment from the plan Service code 29 | — | $12K |
| CHUBB & SON EIN 13-1963496 | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $6K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 | Custodial (other than securities); Direct payment from the plan Service code 18 | — | $5K |
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 | 2,794 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 101 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 2,895 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 6,947 | $3.8M |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 2,779 | $183K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 2,779 | $183K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,947 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.