| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 261 MADISON AVENUE, 5TH FLOOR NEW YORK, NY 10016 | UNITEDHEALTHCARE INSURANCE COMPANY | $56K | $0 | $56K | 1.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 6100 FAIRVIEW ROAD, SUITE 800 CHARLOTTE, NC 28210 | AMERITAS LIFE INSURANCE CORP | $25K | $0 | $25K | 7.51% |
| IBSI HOLDINGS INC3 | PO BOX 24337 WINSTON SALEM, NC 27114 | AMERITAS LIFE INSURANCE CORP | $12K | $0 | $12K | 3.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 220748 CHARLOTTE, NC 28222 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $14K | $0 | $14K | 6.91% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 203508 DALLAS, TX 75320 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $0 | $4K | 2.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 6100 FAIRVIEW ROAD SUITE 1400 CHARLOTTE, NC 28210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 20.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 203508 DALLAS, TX 75320 | ARAG SERVICES, LLC | $609 | $0 | $609 | 9.99% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 663 | $4.2M |
| Dental | AMERITAS LIFE INSURANCE CORP | 0 | $331K |
| Vision | AMERITAS LIFE INSURANCE CORP | 0 | $331K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 501 | $0 |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 501 | $0 |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 501 | $0 |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 663 | $4.2M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 501 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 663 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.