| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | — | $5K | $5K | 2.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| USI BENEFITS CONSULTING NONE | Insurance agents and brokers Service code 22 | 100 SUMMIT LAKE DRIVE SUITE 400 VALHALLA, NY 10595 | $54K |
| CAPFINANCIAL EIN 26-0058143 NONE | Trustee (directed); Other fees Service code 25 | — | $42K |
| AON HEWITT EIN 22-2232264 NONE | Actuarial; Insurance agents and brokers Service code 11 | — | $19K |
| CLARK SCHAEFER HACKETT EIN 31-0800053 NONE | Accounting (including auditing) Service code 10 | — | $17K |
| CUSTOM DESIGN BENEFITS NONE | Plan Administrator Service code 14 | 5589 CHEVIOT ROAD CINCINNATI, OH 45247 | $7K |
| DELTA DENTAL OF OHIO EIN 31-0685339 NONE | Insurance services Service code 23 | — | $7K |
| MATRIX TRUST COMPANY EIN 75-3182674 NONE | Investment management Service code 28 | — | $5K |
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 | 120 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 157 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 286 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICAL MUTUAL | 191 | $6.1M |
| Dental | DELTA DENTAL OF OHIO | 527 | $289K |
| Vision | VISION SERVICE PLAN | 225 | $79K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 172 | $199K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 172 | $199K |
| Prescription drug | MEDICAL MUTUAL | 191 | $6.1M |
| Other | HARTFORD LIFE AND ACCIDENT | 172 | $199K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 527 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.