| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 39000 SAN FRANCISCO, CA 94139 | AETNA HEALTH, INC. | $63K | $0 | $63K | 3.22% |
| USI INSURANCE SERVICES LLC3 | PO BOX 39000 SAN FRANCISCO, CA 94139 | AETNA LIFE INSURANCE COMPANY | $10K | $49 | $10K | 3.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | UNKNOWN COMPTON, CA 90220 | AETNA LIFE INSURANCE COMPANY | $0 | $339 | $339 | 0.10% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | $4K | $20K | 12.15% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $6K | $6K | 3.76% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 5.45% |
| USI INSURANCE SERVICES LLC3 | 580 NORTH 4TH STREET, SUITE 400 COLUMBUS, OH 43215 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 4.55% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $6K | $0 | $6K | 12.39% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 3.19% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $3K | $0 | $3K | 9.91% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
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 | 311 | 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) | 311 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA HEALTH, INC. | 490 | $2.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 218 | $94K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 417 | $29K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 311 | $165K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 311 | $165K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 311 | $165K |
| Prescription drug(2 contracts, 2 carriers) | AETNA HEALTH, INC. | 490 | $2.3M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 311 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 490 | — |
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."
No prospect flags tripped on this filing.