| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | 312 ELM STREET FL 24 CINCINNATI, OH 45202 | UNITEDHEALTHCARE INSURANCE COMPANY | $5K | — | $5K | 0.93% |
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET FL 24 CINCINNATI, OH 45202 | UNITEDHEALTHCARE INSURANCE COMPANY | $901 | — | $901 | 0.17% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $29K | $29K | 5.90% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 61007 VIRGINA BEACH, VA 234661007 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 0.85% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 1 HILLCREST DRIVE EAST CHARLESTON, WV 25311 | METROPOLITAN LIFE INSURANCE COMPANY | — | $51 | $51 | 0.01% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $23K | — | $23K | 28.86% |
| LOUIS R FAIOLA3 Filed as: LOUIS PANTALONE | 897 12TH STREET HAMMONTON, NJ 08037 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 2.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | 312 ELM STREET FL 24 CINCINNATI, OH 45202 | UNITEDHEALTHCARE INSURANCE COMPANY | $615 | — | $615 | 0.93% |
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET FL 24 CINCINNATI, OH 45202 | UNITEDHEALTHCARE INSURANCE COMPANY | $111 | — | $111 | 0.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $628K |
| PREFERRED BENEFITS SERVICES EIN 31-1407150 BROKER | Other commissions Service code 55 | PO BOX 868 DELAWARE, OH 43015 | $0 |
| USI INSURANCE SERVICES LLC EIN 13-3771734 BROKER | Other commissions Service code 55 | 312 ELM STREET FL 24 CINCINNATI, OH 45202 | $0 |
| USI MIDWEST INC EIN 31-0507943 BROKER | Other commissions Service code 55 | 312 ELM STREET FL 24 CINCINNATI, OH 45202 | $0 |
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 | 1,060 | 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) | 1,060 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,871 | $454K |
| Vision | VISION SERVICE PLAN | 976 | $78K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,424 | $493K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,424 | $493K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,424 | $493K |
| Stop-loss / reinsurancereinsurance(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,702 | $602K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,424 | $573K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,424 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.