| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | P.O. BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED HEALTHCARE INSURANCE COMPANY | — | $229K | $229K | 2.04% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | P.O. BOX 61187 VIRGINIA BEACH, VA 23466 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $43K | — | $43K | 10.01% |
| IMG5 | 2960 NORTH MERDIAN ST. INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $329 | $329 | 0.08% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | P.O. BOX 61187 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $25K | — | $25K | 6.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | P.O. BOX 61187 VIRGINIA BEACH, VA 23466 | RELIASTAR LIFE INSURANCE COMPANY | $35K | — | $35K | 18.32% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | P.O. BOX 61187 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $14K | — | $14K | 11.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST | 9811 KATY FREEWAY STE 500 HOUSTON, TX 77024 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $20K | $1K | $21K | 79.25% |
| CUSTOM BENEFITS PROGRAMS3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. AN AO | 897 12TH ST. HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $250 | $1K | $1K | 4.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GSA NATIONAL THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | 4114 LEGATO RD. STE 400 FAIRFAX, VA 22033 | $496K |
| NEW BENEFITS LTD. NONE | Other services Service code 49 | PO BOX 803475 DALLAS, TX 75380 | $102K |
| COMPSYCH | Contract Administrator Service code 13 | — | $14K |
| SALTMARSH, CLEVELAND & GUND, CPA NONE | Accounting (including auditing) Service code 10 | 34 WALTER MARTIN RD. FORT WALTON BEACH, FL 32548 | $9K |
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 | 1,710 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,711 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 1,013 | $11.2M |
| Dental | STANDARD INSURANCE COMPANY | 1,416 | $411K |
| Vision | STANDARD INSURANCE COMPANY | 1,264 | $122K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,563 | $462K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,563 | $435K |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,563 | $638K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,563 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.