| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 777 CANAL VIEW BOULEVARD, SUITE 100 ROCHESTER, NY 14623 | EXCELLUS BLUE CROSS BLUE SHIELD | $20K | — | $20K | 4.44% |
| USI INSURANCE SERVICES LLC3 | 3 LEAR JET LANE SUITE 104 LATHAM, NY 12110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $689 | $2K | 6.57% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS | 1719 ROUTE 10, SUITE 106 PARSIPPANY, NY 07054 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $58 | $1K | 3.83% |
| ALLIANCE ADVISORY GRP INC3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5 | — | $5 | 0.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 1787 SENTRY PKWY W BLUE BELL, PA 19422 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $6K | — | $6K | 22.91% |
| EPSIX, INC.3 Filed as: EPSIX, INC | 13924 E DYER LANE SCOTTSDALE, AZ 85262 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $6K | — | $6K | 22.81% |
| REBECCA PITCHER3 | 287 GENESEE ST STE 102A UTICA, NY 13501 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $1K | — | $1K | 4.76% |
| KYLE SAVNER3 | 2308 VANDY DR PALMYRA, NY 14522 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $1K | — | $1K | 4.29% |
| PLATINUM ENROLLMENT SOLUTIONS3 | 7100 FOUNDRY ROW STE 288-53 LIBERTY TOWNSHIP, OH 45069 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $529 | — | $529 | 1.93% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES | 214 N TRYON ST FL 46 CHARLOTTE, NC 28202 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $380 | — | $380 | 1.38% |
| IQBAL SINGH BAGGA3 | 10510 66TH AVE APT 5C FOREST HILLS, NY 11375 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $58 | — | $58 | 0.21% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62937 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $934 | $3K | 14.22% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62937 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | $754 | $4K | 19.08% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | COMPANION LIFE INSURANCE COMPANY | $1K | $416 | $2K | 13.74% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62937 VIRGINIA BEACH, VA 23466 | COMPANION LIFE INSURANCE COMPANY | $675 | $283 | $958 | 14.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62937 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $90 | $38 | $128 | 14.22% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62937 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $81 | $36 | $117 | 14.43% |
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 | 140 | 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) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 37 | $442K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 49 | $29K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 49 | $29K |
| Life insurance(3 contracts, 3 carriers) | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | 140 | $35K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 113 | $22K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 66 | $18K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 37 | $442K |
| Other(3 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 140 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.