| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 2375 EAST CAMELBACK ROAD, SUITE 250 PHOENIX, AZ 85016 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | $29K | $31K | 3.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| AMWINS3 Filed as: AMWINS ANCILLARY, LLC | 1933 STATE ROUTE 35, SUITE 368 WALL TOWNSHIP, NJ 07719 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.75% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $883 | $883 | 4.30% |
| USI INSURANCE SERVICES LLC3 | 2375 EAST CAMELBACK ROAD, SUITE 250 PHOENIX, AZ 85016 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.91% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $506 | $0 | $506 | 10.79% |
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 | 67 | 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) | 67 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 92 | $781K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 92 | $781K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 94 | $5K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 19 | $10K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 99 | $21K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 99 | $21K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 92 | $781K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 19 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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.