| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 3176 NORFOLK, VA 235143716 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $15K | $9K | $25K | 13.36% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 3176 NORFOLK, VA 235143716 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $14K | $10K | $24K | 14.01% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGOHAN BRABENDER AGCY INC | 3931 S DIXIE DR DAYTON, OH 45439 | COMMUNITY INSURANCE COMPANY (G1728) | $14 | $3K | $3K | 2.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | 312 ELM STREET 24TH FLOOR CINCINNATI, OH 45202 | COMMUNITY INSURANCE COMPANY (G1728) | $3K | — | $3K | 1.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 3176 NORFOLK, VA 235143716 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $9K | $6K | $15K | 13.91% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC | DBA USI INSURANCE SERVICE LLC P.O. BOX 3716 NORFOLK, VA 235143716 | HYATT LEGAL PLANS | $5K | $139 | $5K | 8.76% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC | 312 ELM STREET 24TH FLOOR CINCINNATI, OH 45202 | HYATT LEGAL PLANS | — | $800 | $800 | 1.35% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC | DBA USI INSURANCE SERVICES LLC P.O. BOX 62889 VIRGINIA BEACH, VA 23466 | HYATT LEGAL PLANS | $466 | — | $466 | 0.79% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 3176 NORFOLK, VA 235143716 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $2K | $5K | 13.23% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 3176 NORFOLK, VA 235143716 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $729 | $2K | 13.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY (G1728) EIN 31-1440175 NONE | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $1.1M |
| USI MIDWEST INC EIN 31-0507943 NONE | Other commissions; Insurance brokerage commissions and fees Service code 53 | — | $65K |
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 | 3,550 | 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) | 3,550 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 3,994 | $723K |
| Vision | COMMUNITY INSURANCE COMPANY (G1728) | 1,626 | $160K |
| Life insurance(3 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 3,550 | $234K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,661 | $174K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,410 | $110K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY (G1728) | 2,498 | $800K |
| Other(3 contracts, 2 carriers) | HYATT LEGAL PLANS | 3,550 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,994 | — |
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.