| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | P O BOX 62939 ATTN NORTHEAST VIRGINIA BEACH, VA 23466 | EMPIRE HEALTHCHOICE ASSURANCE INC | $40K | $96 | $40K | 1.47% |
| USI INSURANCE SERVICES LLC3 | P O BOX 20138 ATLANTA, GA 30325 | UNUM LIFE INSURANCE COMPANY | $15K | $1K | $16K | 10.75% |
| USI INSURANCE SERVICES LLC3 | P O BOX 20138 ATLANTA, GA 30325 | FIRST UNUM LIFE INSURANCE COMPANY | $6K | $282 | $6K | 15.75% |
| USI INSURANCE SERVICES LLC3 | P O BOX 20138 ATLANTA, GA 30325 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $348 | $4K | 11.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 CLAIMS ADMIN | Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | 9 PINE STREET 14TH FLOOR NEW YORK, NY 10005 | $6K |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE INC | 341 | $2.8M |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE INC | 341 | $2.8M |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY | 274 | $186K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY | 274 | $148K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 274 | $148K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY | 274 | $218K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 341 | — |
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.