| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SAVOY ASSOCIATES3 | 200 CONNELL DR SUITE 100 BERKELEY HEIGHTS, NJ 07922 | HORIZON HEALTHCARE SERVICES, INC. | $27K | $6K | $33K | 5.85% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | RELIASTAR LIFE INSURANCE COMPANY | $20K | — | $20K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DR STE 400 VALHALLA, NY 10595 | RELIASTAR LIFE INSURANCE COMPANY | $20K | — | $20K | 9.96% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | NATIONAL VISION ADMINISTRATORS, LLC | $1K | — | $1K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMPCARE HEALTH SERVICES INSURANCE EIN 39-1462554 ADMIN | Claims processing; Contract Administrator Service code 12 | — | $312K |
| HUMANA EIN 31-0935772 MEDICAL ADMIN | Claims processing; Contract Administrator Service code 12 | — | $35K |
| DELTA DENTAL OF WI EIN 39-6094742 DENTAL ADMIN | Contract Administrator; Claims processing Service code 12 | — | $10K |
| USI INSURANCE SERVICES LLC BROKER | Insurance agents and brokers Service code 22 | 711 EISENHOWER DR KIMBERLY, WI 54136 | $156 |
| INGENIORX, INC. EIN 82-3062245 ADMIN | Contract Administrator; Claims processing Service code 12 | — | $0 |
| USI INSURANCE SERVICES, LLC BROKER | Insurance agents and brokers Service code 22 | 201 ALGAMBRA CIRCLE STE 801 CORAL GABLES, FL 33134 | $0 |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HORIZON HEALTHCARE SERVICES, INC. | 38 | $562K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 203 | $24K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 315 | $202K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY | 315 | $202K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 315 | $202K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 315 | — |
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.
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.