| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $0 | $61K | $61K | 0.23% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $0 | $13K | $13K | 0.23% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $52K | $4K | $56K | 3.53% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $5K | $39K | $43K | 5.63% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $0 | $602 | $602 | 0.23% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE COMPANY | $561 | $0 | $561 | 0.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS ADMINISTRATORS EIN 38-2384171 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $712K |
| EMPLOYEE 001 EIN 31-6654730 EMPLOYEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $327K |
| USI INSURANCE SERVICES LLC NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 21250 HAWTHORNE BLVD SUITE 380 TORRANCE, CA 90250 | $250K |
| WITHUMSMITH+BROWN, PC EIN 22-2027092 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $184K |
| ELLENOFF GROSSMAN & SCHOLE LLP EIN 13-3643185 NONE | Legal; Direct payment from the plan Service code 29 | — | $182K |
| ACTUM LLC NONE | Direct payment from the plan; Consulting (general) Service code 16 | 767 S ALAMEDA ST SUITE 490 LOS ANGELES, CA 90021 | $100K |
| TAYLOR AND TAYLOR ASSOCIATES, INC NONE | Consulting (general); Direct payment from the plan; Insurance services Service code 16 | 271 MADISON AVENUE 5TH FLOOR NEW YORK, NY 10016 | $86K |
| SYNERGY ENROLLMENT & BENEFITS, LLC NONE | Direct payment from the plan; Other services Service code 49 | 3550 CAMINO DEL RIO N SUITE 207 SAN DIEGO, CA 92108 | $80K |
| EMPLOYEE 002 EIN 31-6654730 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $75K |
| MILL CREEK CAPITAL ADVISORS, LLC EIN 41-2212501 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $54K |
| EMPLOYEE 003 EIN 31-6654730 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $40K |
| INNOVATION HEALTH, LLC NONE | Other services; Direct payment from the plan Service code 49 | 3847 NEWHAVEN LAKE DRIVE WELLINGTON, FL 33449 | $38K |
| EMPLOYEE 004 EIN 31-6654730 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $12K |
| APERIO GROUP, LLC EIN 68-0436509 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $10K |
| US BANK EIN 41-0255900 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $9K |
| SMART SOURCE LLC EIN 30-0830429 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $9K |
| JUSTIN POLLOCK EIN 31-6654730 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $7K |
| DANIEL ROSENTHAL EIN 31-6654730 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $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 | 2,422 | 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) | 2,422 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 1,444 | $31.8M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,921 | $1.6M |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,921 | $1.6M |
| Life insurance(3 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,921 | $2.6M |
| Short-term disability(3 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,921 | $2.6M |
| Long-term disability(3 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,921 | $2.6M |
| Other(3 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,921 | $2.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,921 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.