| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $0 | $13K | $13K | 1.70% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 380 TORRANCE, CA 90503 | HARTFORD LIFE AND ACCIDENT | $0 | $1K | $1K | 0.19% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $84 | $11K | 5.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 3.67% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $102 | $0 | $102 | 0.05% |
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $40 | $0 | $40 | 0.02% |
| HODGES-MACE BENEFITS GRP INC3 Filed as: HODGES-MACE BENEFITS GROUP | 3350 RIVERWOOD PARKWAY, SUITE 80 ATLANTA, GA 30339 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $30 | $0 | $30 | 0.01% |
| HODGES-MACE BENEFITS GRP INC3 Filed as: HODGES-MACE BENEFITS GROUP | 3350 RIVERWOOD PARKWAY, SUITE 80 ATLANTA, GA 30339 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.57% |
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.57% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $850 | $170 | $1K | 1.23% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $556 | $0 | $556 | 0.67% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN TORRANCE, CA 90503 | ESI EMPLOYEE ASSISTANCE GROUP | $11K | $0 | $11K | 30.00% |
| HODGES-MACE BENEFITS GRP INC3 Filed as: HODGES-MACE BENEFITS GROUP | 3350 RIVERWOOD PARKWAY, SUITE 80 ATLANTA, GA 30339 | FIRST UNUM LIFE INSURANCE COMPANY | $280 | $0 | $280 | 2.15% |
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | FIRST UNUM LIFE INSURANCE COMPANY | $144 | $0 | $144 | 1.11% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD 6TH FLOOR TORRANCE, CA 90503 | FIRST UNUM LIFE INSURANCE COMPANY | $120 | $0 | $120 | 0.92% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET, SUITE 1200 WOODLAND HILLS, CA 91367 | FIRST UNUM LIFE INSURANCE COMPANY | $62 | $0 | $62 | 0.48% |
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 | 2,162 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 57 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,219 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 414 | $2.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,484 | $1.1M |
| Vision | VISION SERVICE PLAN | 1,406 | $173K |
| Life insurance(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 2,162 | $834K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,162 | $982K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,162 | $982K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 414 | $2.8M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 2,162 | $978K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,162 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.