| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 726 EXCHANGE STREET, SUITE 618 BUFFALO, NY 14210 | STANDARD INSURANCE COMPANY | $11K | — | $11K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 475 KILVERT STREET, BUILDING B SUITE 205 WARWICK, RI 02886 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 1.29% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | STANDARD INSURANCE COMPANY | — | -$938 | -$938 | -0.86% |
| USI INSURANCE SERVICES LLC3 | 726 EXCHANGE STREET, SUITE 618 BUFFALO, NY 14210 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 10.95% |
| ROBERT E. MILLER INSURANCE AGENCY3 Filed as: ROBERT E MILLER INSURANCE AGENCY | 903 E 104TH STREET, SUITE 800 KANSAS CITY, MO 64131 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 3.80% |
| USI INSURANCE SERVICES LLC3 | 475 KILVERT STREET, BUILDING B SUITE 205 WARWICK, RI 02886 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 2.86% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | STANDARD INSURANCE COMPANY | — | -$1K | -$1K | -2.84% |
| USI INSURANCE SERVICES LLC3 | 726 EXCHANGE STREET, SUITE 618 BUFFALO, NY 14210 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 7.19% |
| ROBERT E. MILLER INSURANCE AGENCY3 Filed as: ROBERT E MILLER INSURANCE AGENCY | 903 E 104TH STREET, SUITE 800 KANSAS CITY, MO 64131 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 2.57% |
| USI INSURANCE SERVICES LLC3 | 475 KILVERT STREET, BUILDING B SUITE 205 WARWICK, RI 02886 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 2.51% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | STANDARD INSURANCE COMPANY | — | -$1K | -$1K | -2.69% |
| USI INSURANCE SERVICES LLC3 | 726 EXCHANGE STREET, SUITE 618 BUFFALO, NY 14210 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 7.14% |
| USI INSURANCE SERVICES LLC3 | 475 KILVERT STREET, BUILDING B SUITE 205 WARWICK, RI 02886 | STANDARD INSURANCE COMPANY | — | $698 | $698 | 2.56% |
| ROBERT E. MILLER INSURANCE AGENCY3 Filed as: ROBERT E MILLER INSURANCE AGENCY | 903 E 104TH STREET, SUITE 800 KANSAS CITY, MO 64131 | STANDARD INSURANCE COMPANY | $682 | — | $682 | 2.50% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | STANDARD INSURANCE COMPANY | — | -$690 | -$690 | -2.53% |
| USI INSURANCE SERVICES LLC3 | 726 EXCHANGE STREET, SUITE 618 BUFFALO, NY 14210 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 475 KILVERT STREET, BUILDING B SUITE 205 WARWICK, RI 02886 | STANDARD INSURANCE COMPANY | — | $239 | $239 | 1.32% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | STANDARD INSURANCE COMPANY | — | -$150 | -$150 | -0.83% |
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 | 257 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 257 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | STANDARD INSURANCE COMPANY | 213 | $110K |
| Vision | STANDARD INSURANCE COMPANY | 183 | $18K |
| Life insurance | STANDARD INSURANCE COMPANY | 257 | $50K |
| Short-term disability | STANDARD INSURANCE COMPANY | 241 | $47K |
| Long-term disability | STANDARD INSURANCE COMPANY | 84 | $27K |
| Other | STANDARD INSURANCE COMPANY | 257 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 257 | — |
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.