| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 21 CONGRESS STREET, SUITE 202 SARASOTA SRINGS, NY 12866 | CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC. | $34K | $0 | $34K | 4.05% |
| USI INSURANCE SERVICES LLC3 | 75 JOHN ROBERTS ROAD BUILDING C SOUTH PORTLAND, ME 04106 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $3K | $0 | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | COMPANION LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.39% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | COMPANION LIFE INSURANCE COMPANY | $2K | $0 | $2K | 6.69% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | $0 | $1K | 5.68% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $781 | $0 | $781 | 3.61% |
| USI INSURANCE SERVICES LLC3 | 333 GLENN STREET GLENS FALL, NY 12801 | THE PAUL REVERE LIFE INSURANCE COMPANY | $861 | $0 | $861 | 7.56% |
| LORRAINE RHODES3 | 4A KENSINGTON COURT CLIFTON PARK, NY 12065 | THE PAUL REVERE LIFE INSURANCE COMPANY | $661 | $0 | $661 | 5.80% |
| BRIAN BEAUCHEMIN3 Filed as: BRIAN BAUCHEMIN | 334 GRAY STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $87 | $2 | $89 | 0.78% |
| DONALD H MATSON3 Filed as: DONALD H. MATSON | 8 ROSEWOOD DRIVE AUBRUN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $47 | $20 | $67 | 0.59% |
| MJ INSURANCE3 Filed as: ERIC PEREZ AND VARIOUS AGENTS | 1274 CROES AVENUE BRONX, NY 10472 | THE PAUL REVERE LIFE INSURANCE COMPANY | $45 | $4 | $49 | 0.43% |
| MELISSA PINE3 | 334 GRAY STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $37 | $6 | $43 | 0.38% |
| TRACEY TWAROG3 | 4303 CONSAUL ROAD SCHENECTADY, NY 12304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $35 | $0 | $35 | 0.31% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. CO. OF NY | $227 | $0 | $227 | 3.15% |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC. | 165 | $841K |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 87 | $62K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. CO. OF NY | 128 | $7K |
| Life insurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 120 | $50K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 120 | $22K |
| Prescription drug | CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC. | 165 | $841K |
| Other(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 120 | $33K |
| 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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.