| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 190 RIVERS RD SUMMIT, NJ 07901 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $710 | $15K | 15.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 190 RIVERS RD SUMMIT, NJ 07901 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9K | $1K | $10K | 13.44% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $154 | $2K | 2.21% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $154 | $2K | 2.21% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 190 RIVERS RD SUMMIT, NJ 07901 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $902 | $14K | 24.65% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $166 | $4K | 6.89% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $166 | $4K | 6.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 190 RIVERS RD SUMMIT, NJ 07901 | FIRST UNUM LIFE INSURANCE COMPANY | $132 | $4 | $136 | 11.70% |
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 | 188 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 188 | $95K |
| Short-term disability(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 128 | $78K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 188 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 188 | — |
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.