| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | 400 HIGHWAY 169, SUITE 800 MINNEAPOLIS, MN 55426 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $2K | $6K | 5.46% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | 400 HIGHWAY 169, SUITE 800 MINNEAPOLIS, MN 55426 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $1K | $5K | 5.90% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | 400 HIGHWAY 169, SUITE 800 MINNEAPOLIS, MN 55426 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $482 | $4K | 14.92% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES NATIONAL | PO BOX 203373 DALLAS, TX 753203373 | EYEMED VISION CARE C/O FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 9.22% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INSURANCE | PO BOX 203373 DALLAS, TX 753203373 | EYEMED VISION CARE C/O FIDELITY SECURITY LIFE INSURANCE COMPANY | $88 | — | $88 | 0.78% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | 400 HIGHWAY 169, SUITE 800 MINNEAPOLIS, MN 55426 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $150 | $1K | 16.97% |
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 | 261 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 145 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 41 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 447 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE C/O FIDELITY SECURITY LIFE INSURANCE COMPANY | 147 | $11K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 411 | $117K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 145 | $89K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 95 | $25K |
| Stop-loss / reinsurancereinsurance | MEDICA INSURANCE COMPANY | 750 | $437K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 268 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 750 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.