| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | 7 GIRALDA FARMS 2ND FLOOR MADISON, NJ 07940 | BLUE CROSS BLUE SHIELD OF TEXAS | $127K | $6K | $133K | 2.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | 580 N. 4TH STREET SUITE 400 COLUMBUS, OH 43215 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $17K | $0 | $17K | 3.75% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE SUITE 350 VALHALLA, NY 10595 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 1.25% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | P.O. BOX 62939 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $15K | $60 | $15K | 12.15% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1018 W. 9TH AVENUE SUITE 100 KING OF PRUSSIA, PA 19406 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.51% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | P.O. BOX 62939 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | $795 | $17K | 15.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | P.O. BOX 62939 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $1K | $11K | 11.32% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | UNIT 208 648 VILLAGE PARK DR WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $644 | $4K | 4.38% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $184 | $4K | 3.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | P.O. BOX 62939 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $524 | $10K | 13.40% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | UNIT 208 648 VILLAGE PARK DR WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $543 | $4K | 5.16% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $132 | $3K | 4.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | 180 PARK AVENUE SUITE 102 FLORHAM PARK, NJ 07932 | HM LIFE INSURANCE COMPANY | $6K | $0 | $6K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | P.O. BOX 62939 VIRGINIA BEACH, VA 23466 | FIRST UNUM LIFE INSURANCE COMPANY | $149 | $22 | $171 | 34.48% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | UNIT 208 648 VILLAGE PARK DR WILMINGTON, NC 28405 | FIRST UNUM LIFE INSURANCE COMPANY | $74 | $9 | $83 | 16.73% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD STE 206 ROSWELL, GA 30075 | FIRST UNUM LIFE INSURANCE COMPANY | $74 | $4 | $78 | 15.73% |
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 | 1,079 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,087 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF TEXAS | 1,121 | $6.6M |
| Dental(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 749 | $584K |
| Vision | HM LIFE INSURANCE COMPANY | 554 | $55K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 749 | $234K |
| Short-term disability(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 159 | $95K |
| Other(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 749 | $308K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,121 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.