| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 2975 REGENT BOULEVARD IRVING, TX 75063 | HUMANA INSURANCE COMPANY | $3K | $0 | $3K | 3.43% |
| UPFSA INSURANCE AGENCY OF AZ, INC.3 Filed as: UPFSA INSURANCE AGENCY OF ARIZONA | 7333 EAST DOUBLETREE RANCH ROAD SUITE 120 SCOTTSDALE, AZ 85258 | METROPOLITAN LIFE INSURANCE COMPANY | $798 | $0 | $798 | 1.81% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 5600 BLAZER PARKWAY SUITE 300 DUBLIN, OH 43017 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $498 | $2K | 7.62% |
| BARBARA A. RHYMER3 | 580 NORTH 4TH STREET, SUITE 400 COLUMBUS, OH 43215 | PRINCIPAL LIFE INSURANCE COMPANY | $303 | $151 | $454 | 1.73% |
| BARBARA A. RHYMER3 | 580 NORTH FOURTH STREET, SUITE 400 COLUMBUS, OH 43215 | PRINCIPAL LIFE INSURANCE COMPANY | $74 | $0 | $74 | 0.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 5600 BLAZER PARKWAY, SUITE 300 DUBLIN, OH 43017 | PRINCIPAL LIFE INSURANCE COMPANY | $51 | $17 | $68 | 0.26% |
| MARK A. BLUMENTHAL3 Filed as: MARK W. PFISTER | 400 WEST WILSON BRIDGE ROAD SUITE 260 WORTHINGTON, OH 43085 | PRINCIPAL LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 203373 DALLAS, TX 75320 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 7.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203373 DALLAS, TX 75320 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $523 | $0 | $523 | 8.47% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 2975 REGENT BOULEVARD IRVING, TX 75063 | HUMANA BENEFIT PLAN OF ILLINOIS, INC. | $100 | $0 | $100 | 5.11% |
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 | 243 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 252 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 55 | $102K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 67 | $6K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 31 | $65K |
| Long-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 31 | $47K |
| Prescription drug(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 55 | $102K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 243 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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.