| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NA | PO BOX 62819 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | — | $11K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 203508 DALLAS, TX 75320 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT ADMINISTRATIVE SYSTEMS, LLC EIN 36-4197088 CLAIMS ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $196K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATION | Contract Administrator; Direct payment from the plan; Named fiduciary; Non-monetary compensation; Claims processing; Float revenue; Participant communication; Other services Service code 12 | — | $17K |
| STANLEY BENEFIT SERVICES, INC. EIN 20-4006400 CLAIMS ADMINISTRATION | Plan Administrator; Claims processing Service code 12 | 7800 MCCLOUD ROAD, STE. 200 GREENSBORO, NC 27409 | $15K |
| EXPRESS SCRIPTS CLAIMS ADMINISTRATION | Contract Administrator Service code 13 | 1 EXPRESS WAY ST. LOUIS, MO 63121 | $11K |
| TELADOC HEALTH INC. CLAIMS ADMINISTRATION | Contract Administrator Service code 13 | PO BOX 123417 DALLAS, TX 753123417 | $11K |
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 | 606 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 611 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 414 | $39K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 702 | $91K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 184 | $106K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 606 | $33K |
| Stop-loss / reinsurancereinsurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 505 | $258K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 606 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 702 | — |
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."
No prospect flags tripped on this filing.