| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61187 VIRGINIA BEACH, VA 23466 | BLUE CROSS BLUE SHIELD OF ARIZONA | $57K | — | $57K | 12.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 7535 IRVINE CENTER DRIVE SUITE 250 IRVINE, CA 92618 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14K | $4K | $18K | 8.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61187 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 19.41% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61187 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $3K | — | $3K | 9.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 NONE | Contract Administrator; Direct payment from the plan; Plan Administrator; Claims processing Service code 12 | — | $265K |
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 | 257 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 262 | $478K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 283 | $207K |
| Vision | VISION SERVICE PLAN | 218 | $30K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 283 | $207K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 283 | $207K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 283 | $207K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 262 | $478K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF ARIZONA | 262 | $478K |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 283 | $275K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 283 | — |
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.