| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | $16K | $19K | 9.59% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $17K | $0 | $17K | 8.46% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $7K | $7K | 3.65% |
| PATRIOT GROWTH INSURANCE SERVICES5 Filed as: PATRIOT GROWTH INSURANCE SVCS., LLC | 500 SILVER SPUR ROAD, SUITE 121 ROLLING HILLS ESTATE, CA 90275 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $2K | $2K | 1.23% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | COMPANION LIFE INSURANCE COMPANY | $0 | $7K | $7K | 12.50% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | COMPANION LIFE INSURANCE COMPANY | $936 | $5K | $6K | 10.53% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | COMPANION LIFE INSURANCE COMPANY | $5K | $0 | $5K | 8.40% |
| PATRIOT GROWTH INSURANCE SERVICES5 Filed as: PATRIOT GROWTH INSURANCE SVCS., LLC | 500 SILVER SPUR ROAD, SUITE 121 ROLLING HILLS ESTATE, CA 90275 | COMPANION LIFE INSURANCE COMPANY | $0 | $2K | $2K | 4.20% |
| USI INSURANCE SERVICES LLC3 | 222 SOUTH RIVERSIDE PLAZA SUITE 900 CHICAGO, IL 60606 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $1K | $5K | 13.70% |
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 | 449 | 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) | 449 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 482 | $861K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 380 | $37K |
| Life insurance(3 contracts, 3 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 449 | $258K |
| Short-term disability(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 449 | $200K |
| Long-term disability(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 449 | $200K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 482 | $861K |
| Other(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 449 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 482 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.