| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 10.20% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS, INC. | 333 INDIAN HILL BOULEVARD CLAREMONT, CA 91711 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $198 | — | $198 | 0.14% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | EYEMED | $3K | — | $3K | 8.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 3190 FAIRVIEW PARK DRIVE, SUITE 400 FALLS CHURCH, VA 22042 | DELAWARE AMERICAN LIFE INSURANCE COMPANY | $3K | — | $3K | 7.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1390 WILLOW PASS ROAD, SUITE 410 CONCORD, CA 94520 | EYEMED | $1K | — | $1K | 4.41% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | HYATT LEGAL PLANS | $594 | — | $594 | 6.72% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | HYATT LEGAL PLANS | $289 | $29 | $318 | 3.60% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 300 EAST MAIN STREET, SUITE 1300 NORFOLK, VA 23510 | HYATT LEGAL PLANS | — | $27 | $27 | 0.31% |
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 | 79 | 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) | 79 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 4 | $40K |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $178K |
| Vision(2 contracts) | EYEMED | 641 | $72K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $178K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $138K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $138K |
| Other(4 contracts, 4 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $190K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 641 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.