| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL,INC | 444 LIBERTY AVENUE, SUITE 1500 PITTSBURGH, PA 15222 | UPMC HEALTH OPTIONS | $54K | — | $54K | 2.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL,INC | 444 LIBERTY AVENUE, SUITE 1500 PITTSBURGH, PA 15222 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 7.42% |
| USI INSURANCE SERVICES LLC4 Filed as: USI INSURANCE SVCS LLC-MIDATLANTIC | P.O. BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.26% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC-MIDATLANTIC | P.O. BOX 61007 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF PENNSYLVANIA | $2K | — | $2K | 4.15% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL,INC | 444 LIBERTY AVENUE, SUITE 1500 PITTSBURGH, PA 15222 | DELTA DENTAL OF PENNSYLVANIA | $506 | — | $506 | 0.84% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL,INC | 400 HIGHWAY 169 S, 8TH FLOOR ST. LOUIS PARK, MN 55426 | HIGHMARK, INC. | $519 | — | $519 | 2.98% |
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 | 143 | 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) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UPMC HEALTH OPTIONS | 247 | $1.9M |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 256 | $60K |
| Vision | HIGHMARK, INC. | 258 | $17K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $109K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $109K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $109K |
| Prescription drug | UPMC HEALTH OPTIONS | 247 | $1.9M |
| Other(3 contracts, 3 carriers) | UPMC HEALTH OPTIONS | 247 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 258 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.