| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | 800 STATE STREET, SUITE 200 ERIE, PA 16501 | HIGHMARK BLUE CROSS BLUE SHIELD OF WESTERN NY | $11K | $0 | $11K | 7.78% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN & ASSOCIATES | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 07719 | PROVIDENT LIFE AND CASUALTY INSUANCE COMPANY | $4K | $3K | $8K | 9.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | 726 EXCHANGE STREET, SUITE 618 BUFFALO, NY 14210 | PROVIDENT LIFE AND CASUALTY INSUANCE COMPANY | $0 | $2K | $2K | 2.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | FIRST UNUM LIFE INSURANCE COMPANY | $9K | $347 | $9K | 13.06% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN & ASSOCIATES | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 07719 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $413 | $3K | 4.95% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | 726 EXCHANGE STREET, SUITE 618 BUFFALO, NY 14210 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | $207 | $2K | 2.83% |
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 | 129 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK BLUE CROSS BLUE SHIELD OF WESTERN NY | 303 | $141K |
| Dental | PROVIDENT LIFE AND CASUALTY INSUANCE COMPANY | 131 | $87K |
| Vision | PROVIDENT LIFE AND CASUALTY INSUANCE COMPANY | 131 | $87K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 81 | $69K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 81 | $69K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 81 | $69K |
| Prescription drug | HIGHMARK BLUE CROSS BLUE SHIELD OF WESTERN NY | 303 | $141K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 81 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.