| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 601478 CHARLOTTE, NC 282601478 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $14K | $0 | $14K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | PO BOX 601478 CHARLOTTE, NC 282601478 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 0.50% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $378 | $378 | 0.14% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL LLC | PO BOX 203383 DALLAS, TX 753203381 | STANDARD INSURANCE COMPANY | $4K | $0 | $4K | 4.80% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL LLC | PO BOX 203383 DALLAS, TX 753203381 | STANDARD INSURANCE COMPANY | $3K | $0 | $3K | 4.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF PENNSYLVANIA EIN 23-1667011 ADMIN | Claims processing Service code 12 | — | $40K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 ADMIN | Claims processing Service code 12 | — | $14K |
| NATIONAL VISION ADMINSTRATORS EIN 74-3033381 ADMIN | Claims processing Service code 12 | — | $6K |
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 | 989 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,003 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 989 | $364K |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 970 | $341K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 970 | $278K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 989 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.