| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE SUITE 350 VALHALLA, NY 10595 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | $6K | $15K | 6.76% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $3K | — | $3K | 1.68% |
| USI INSURANCE SERVICES LLC3 | ATTN MID ATLANTIC 4605 COLUMBUS STREET VIRGINIA BEACH, VA 23466 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 13.26% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | MIDATLANTIC-VIRGINIA PO BOX 61007 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $498 | — | $498 | 20.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | WEST-SAN FRANCISCO PO BOX 66119 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $49 | — | $49 | 1.97% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $48 | $48 | 1.93% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $8 | $8 | 0.32% |
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 | 313 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 29 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 342 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 304 | $156K |
| Vision | ANTHEM BLUE CROSS BLUE SHIELD | 540 | $864K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 277 | $227K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 277 | $227K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 277 | $227K |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS BLUE SHIELD | 540 | $864K |
| Other(3 contracts, 3 carriers) | LEGAL RESOURCES, INC. | 251 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 540 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.