| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL, IN | 8000 NORMAN CENTER DRIVE SUITE 400 BLOOMINGTON, MN 55437 | HORIZON HEALTHCARE SERVICES, INC - HEALTH | $31K | — | $31K | 1.84% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL, IN | 8000 NORMAN CENTER DRIVE SUITE 400 BLOOMINGTON, MN 55437 | HORIZON HEALTHCARE SERVICES, INC - PRESCRIPTION DRUG | $12K | $0 | $12K | 2.36% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL, IN | 8000 NORMAN CENTER DRIVE SUITE 400 BLOOMINGTON, MN 55437 | HORIZON HEALTHCARE SERVICES, INC - DENTAL | $2K | $0 | $2K | 4.61% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 6100 FAIRVIEW ROAD 14TH FLOOR CHARLOTTE, NC 282220748 | DEARBORN NATIONAL LIFE INSURANCE COMPANY-LIFE & ADD | $2K | $1K | $3K | 17.14% |
| USI INSURANCE SERVICES LLC8 Filed as: USI INSURANCE SERVICES NATIONAL, IN | PO BOX 203066 DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $448 | $2K | 12.79% |
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 | 175 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HORIZON HEALTHCARE SERVICES, INC - HEALTH | 165 | $1.7M |
| Dental | HORIZON HEALTHCARE SERVICES, INC - DENTAL | 176 | $49K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY-LIFE & ADD | 175 | $20K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 79 | $12K |
| Prescription drug | HORIZON HEALTHCARE SERVICES, INC - PRESCRIPTION DRUG | 167 | $488K |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY-LIFE & ADD | 175 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 176 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.