| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 218060 HOUSTON, TX 77218 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | — | $5K | 0.35% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $36K | — | $36K | 3.47% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $10K | $10K | 0.99% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $432 | $432 | 0.04% |
| LOCKTON COMPANIES, LLC3 | PO BOX 123042 DALLAS, TX 75312 | ARAG SERVICES, LLC | $3K | — | $3K | 9.19% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61187 VIRGINIA BEACH, VA 23462 | ARAG SERVICES, LLC | $294 | — | $294 | 0.81% |
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 | 1,097 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 92 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,189 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 206 | $822K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,105 | $1.5M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,535 | $1.0M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,535 | $1.0M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,535 | $1.0M |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 206 | $822K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,535 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,535 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.