| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8K | — | $8K | 7.26% |
| MJ INSURANCE3 Filed as: JEFFREY THOMAS AND VARIOUS AGENTS | PO BOX 11312 TEMPE, AZ 85284 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $355 | $6K | 5.08% |
| SUSAN HENDRICKS3 | 6718 NORTH PALM CANYON DRIVE PHOENIX, AZ 85018 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $461 | $4K | 3.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2375 EAST CALEMBACK ROAD PHOENIX, AZ 85016 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $216 | $3K | 2.88% |
| GENTRY INSURANCE INC3 Filed as: GENTRY INSURANCE, INC. | 9140 WEST COOLBROOK AVENUE PEORIA, AZ 85382 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $116 | $3K | 2.32% |
| KATHRYN LOUISE BALDWIN3 | 591 WEST MINTON DRIVE TEMPE, AZ 85282 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $62 | $2K | 1.87% |
| HANNA ELIZABETH STONE3 | 1675 EAST CIELO GRANDE AVENUE PHOENIX, AZ 85024 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $106 | $2K | 1.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3727 NORFOLK, VA 23514 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $134 | $2K | 7.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $881 | — | $881 | 10.01% |
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 | 114 | 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) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 98 | $29K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 120 | $9K |
| Life insurance | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 114 | $114K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 114 | $114K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 114 | $114K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 120 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.