| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | PO BOX 3727 NORFOLK, VA 23514 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 5.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC EIN 35-0781558 HEALTH INSURANCE PROVIDER | Float revenue; Claims processing; Other services; Other fees; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 1721 MAGNAVOX WAY FORT WAYNE, IN 46804 | $736K |
| EXPRESS SCRIPTS, INC EIN 31-1714795 PRESCRIPTION PROVIDER | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 1721 MAGNAVOX WAY FORT WAYNE, IN 46804 | $0 |
| USI MIDWEST LLC EIN 35-0781558 SERVICE PROVIDER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 312 ELM ST 24TH FL CINCINNATI, OH 45202 | $0 |
| WELLS FARGO INS SERVICES USA INC EIN 35-0781558 SERVICE PROVIDER | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | PO BOX 885 FORT WAYNE, IN 46801 | $0 |
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 | 1,706 | 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) | 1,706 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 1,706 | $174K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 1,706 | $174K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC | 780 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,706 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.