| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 630 WEST GERMANTOWN PIKE, SUITE 200 PLYMOUTH MEETING, PA 19462 | CALIFORNIA PHYSICIANS SERVICE | $39 | $33K | $33K | 3.14% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $24K | $0 | $24K | 2.48% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $6K | $20K | 14.51% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $7 | $7 | 0.01% |
| USI INSURANCE SERVICES LLC3 | 180 PARK AVENUE, 1ST FLOOR FLORHAM PARK, NJ 07932 | HARTFORD LIFE AND ACCIDENT | $7K | $0 | $7K | 4.90% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $6K | $0 | $6K | 4.14% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 29840 NETWORK PLACE CHICAGO, IL 60673 | VISION SERVICE PLAN | $3K | $0 | $3K | 12.98% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | GERBER LIFE INSURANCE COMPANY | $274 | $0 | $274 | 15.03% |
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 | 36 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 112 | $2.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 228 | $137K |
| Vision | VISION SERVICE PLAN | 73 | $22K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 180 | $134K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 180 | $134K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 180 | $134K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 112 | $2.0M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 180 | $136K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.