| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 400 HIGHWAY 169 SOUTH SAINT LOUIS PARK, MN 55426 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $47K | $0 | $47K | 1.56% |
| USI INSURANCE SERVICES LLC3 | 2375 EAST CAMELBACK ROAD, SUITE 250 PHOENIX, AZ 85016 | EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC. | $57K | $0 | $57K | 3.50% |
| USI INSURANCE SERVICES LLC3 | 400 HIGHWAY 169 SOUTH SAINT LOUIS PARK, MN 55426 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $47K | $15K | $62K | 16.09% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $0 | $11K | 2.95% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203373 DALLAS, TX 75320 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $5K | $0 | $5K | 9.62% |
| USI INSURANCE SERVICES LLC3 | 222 SOUTH RIVERSIDE PLAZA SUITE 900 CHICAGO, IL 60606 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $98 | $1K | 22.61% |
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 | 777 | 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) | 777 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 499 | $4.6M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 910 | $47K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 777 | $384K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 777 | $384K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 777 | $384K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 499 | $4.6M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 777 | $389K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 910 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.