| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 75 JOHN ROBERTS ROAD BUILDING C SOUT PORTLAND, ME 04106 | AETNA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 5.32% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: RIVERTAN RISK MANAGEMENT, LLC | UNKNOWN TINTON FALLS, NJ 07724 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $981 | $0 | $981 | 8.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE | $696 | $0 | $696 | 6.64% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 530 PRESTON AVENUE 3RD FLOOR MERIDEN, CT 06450 | AIG/NATIONAL UNION FIRE INSURANCE OF PITTSBURGH, PA | $188 | $0 | $188 | 15.04% |
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 | 138 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | 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)(2 contracts, 2 carriers) | AETNA INTERNATIONAL BENEFITS PLAN | 36 | $169K |
| Dental(2 contracts, 2 carriers) | AETNA INTERNATIONAL BENEFITS PLAN | 185 | $193K |
| Vision(2 contracts, 2 carriers) | AETNA INTERNATIONAL BENEFITS PLAN | 164 | $157K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $0 |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 20 | $12K |
| Prescription drug | KASIER FOUNDATION HEALTH PLAN OF HAWAII | 4 | $22K |
| Other(2 contracts, 2 carriers) | AIG/NATIONAL UNION FIRE INSURANCE OF PITTSBURGH, PA | 138 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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.