| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 975 OAK STREET, SUITE 900 EUGENE, OR 97401 | PROVIDENCE HEALTH PLAN | $20K | — | $20K | 2.25% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | — | $13K | 8.64% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | VISION SERVICE PLAN | $797 | — | $797 | 7.05% |
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 | 148 | 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) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 315 | $906K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 313 | $149K |
| Vision | VISION SERVICE PLAN | 45 | $11K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 313 | $149K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 313 | $149K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 315 | $906K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 313 | $152K |
| 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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.