| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 100 SUMMIT LAKE DR 400 VALHALLA, NY 10595 | DELTA DENTAL OF MINNESOTA | $3K | — | $3K | 3.18% |
| ASSURANCE AGENCY LTD4 | 1750 E GOLF RD SCHAUMBURG, IL 60173 | DELTA DENTAL OF MINNESOTA | $3K | — | $3K | 2.76% |
| JOSEPH T SNYDER4 | 1021 75TH ST DARIEN, IL 60561 | DELTA DENTAL OF MINNESOTA | $2K | — | $2K | 2.50% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 100 SUMMIT LAKE DR 400 VALHALLA, NY 10595 | DELTA DENTAL OF MINNESOTA | $92 | — | $92 | 0.09% |
| BROKER INCENTIVE PROGRAM0 | PO BOX 9310 MINNEAPOLIS, MN 55391 | MEDICA INSURANCE COMPANY | — | $4K | $4K | 10.06% |
| ASSURANCE AGENCY LTD3 | 1750 E GOLF RD SCHAUMBURG, IL 60173 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 13.69% |
| ASSURANCE AGENCY LTD3 | 1750 E GOLF RD SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $573 | $67 | $640 | 4.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 100 SUMMIT LAKE DR 400 VALHALLA, NY 10595 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $545 | $64 | $609 | 4.65% |
| JOSEPH T SNYDER3 | 1021 75TH ST DARIEN, IL 60561 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $573 | — | $573 | 4.38% |
| ASSURANCE AGENCY LTD4 | 1750 E GOLF RD SCHAUMBURG, IL 60173 | EYE MED | $152 | — | $152 | 3.54% |
| JOSEPH T SNYDER3 | 1021 75TH ST DARIEN, IL 60561 | EYE MED | $152 | — | $152 | 3.54% |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 347 | $36K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF MINNESOTA | 347 | $135K |
| Vision(2 contracts, 2 carriers) | MEDICA INSURANCE COMPANY | 347 | $41K |
| Life insurance | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 23 | $30K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 23 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 347 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.