| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 3475 PIEDMONT RD STE 800 ATLANTA, GA 30305 | SYMETRA LIFE INSURANCE COMPANY | — | $23K | $23K | 2.99% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 3475 PIEDMONT RD STE 800 ATLANTA, GA 30305 | SYMETRA LIFE INSURANCE COMPANY | — | $19K | $19K | 3.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 3475 PIEDMONT RD STE 800 ATLANTA, GA 30305 | SYMETRA LIFE INSURANCE COMPANY | — | $17K | $17K | 3.04% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 3475 PIEDMONT RD STE 800 ATLANTA, GA 30305 | SYMETRA LIFE INSURANCE COMPANY | — | $9K | $9K | 2.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL ADVANTAGE ASSURANCE COMPANY EIN 45-5492167 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $380K |
| USI INSURANCE SERVICES CONSULTANT | Direct payment from the plan; Consulting fees Service code 50 | 1215 MANOR DRIVE MECHANICSBURG, PA 17055 | $175K |
| MAGELLAN RX MANAGEMENT, LLC EIN 46-3708039 PHARMACY BENEFIT MANAGEME | Other fees; Direct payment from the plan; Claims processing Service code 12 | — | $68K |
| BAKER TILLY US, LLP EIN 30-1413443 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | 10 TERRACE CT MADISON, WI 53718 | $24K |
| RXBENEFITS EIN 63-1157085 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $17K |
| TRAVELS INSURANCE NONE | Direct payment from the plan; Insurance services Service code 23 | 485 LEXINGTON AVE 10TH FLOO NEW YORK, NY 10017 | $16K |
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 | 1,295 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,332 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance(4 contracts) | SYMETRA LIFE INSURANCE COMPANY | 407 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 407 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.