| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $65K | $65K | 3.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $13K | $406 | $14K | 10.19% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $370 | $6K | 10.33% |
| A SECURE YOU INC4 Filed as: A SECURE YOU, INC. | 63 SABLE RUN EAST AMHERST, NY 14051 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $87 | $0 | $87 | 8.26% |
| JENNIFER BELL4 | 5445 FOX RUN BOULEVARD FREDERICK, CO 80504 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $32 | $0 | $32 | 3.04% |
| ACRISURE LLC4 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $22 | $0 | $22 | 2.09% |
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 | 165 | 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) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 231 | $1.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 165 | $133K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 165 | $133K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $60K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $60K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $60K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 231 | $1.6M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 231 | — |
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.