| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 777 CANAL VIEW BOULEVARD SUITE 100 ROCHESTER, NY 14623 | EXCELLUS BLUE CROSS BLUE SHIELD | $66K | $0 | $66K | 4.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | $4K | $3K | $7K | 13.89% |
| BENECHOICE ENROLLMENT SOLUTIONS3 Filed as: BENECHOICE ENROLLMENT SOLUTIONS INC | 1574 LITTITZ PIKE LANCASTER, PA 17601 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | $0 | $1K | 2.52% |
| USI INSURANCE SERVICES LLC3 | 530 PRESTON STREET, 3RD FLOOR MERIDEN, CT 06450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $756 | $2K | 13.62% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | COMPANION LIFE INSURANCE COMPANY | $2K | $1K | $3K | 22.43% |
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 | 170 | 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) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 123 | $1.5M |
| Dental | EXCELLUS BLUE CROSS BLUE SHIELD | 123 | $1.5M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 118 | $16K |
| Life insurance(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 170 | $65K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 170 | $51K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 170 | $51K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 123 | $1.5M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 170 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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.