| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES SOUTHWEST | 2711 NORTH HASKELL AVENUE SUITE 2000 DALLAS, TX 75204 | BLUE CROSS BLUE SHIELD OF TEXAS | $214K | $0 | $214K | 5.63% |
| MS BENEFITS3 | 100 CHALLENGER ROAD, SUITE 100 RIDGEFIELD PARK, NJ 07660 | SUN LIFE ASSURANCE COMPANY OF CANADA | $54K | $0 | $54K | 10.13% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES SOUTHWEST | 14241 DALLAS PARKWAY, SUITE 700 DALLAS, TX 75254 | SUN LIFE ASSURANCE COMPANY OF CANADA | $41K | $0 | $41K | 7.62% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $27K | $27K | 5.05% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $51K | $24K | $76K | 20.12% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $17K | $17K | 4.51% |
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 | 980 | 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) | 980 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF TEXAS | 837 | $4.3M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 561 | $534K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 561 | $534K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 980 | $376K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 980 | $376K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 980 | $376K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF TEXAS | 837 | $4.3M |
| Other(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF TEXAS | 980 | $4.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 980 | — |
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.