| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOLLAND INSURANCE, INC.3 Filed as: HOLLAND INSURANCE INC | PO BOX 328 SOUTHAVEN, MS 38671 | COMMUNITY INSURANCE COMPANY | $14K | — | $14K | 7.45% |
| CORNERSTONE BROKER INS SERVICES3 Filed as: CORNERSTONE BROKER INSURANCE SERVIC | 2101 FLORENCE AVE. CINCINNATI, OH 45206 | COMMUNITY INSURANCE COMPANY | — | $7K | $7K | 3.73% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 328 VIRGINIA BEACH, VA 23466 | COMMUNITY INSURANCE COMPANY | $5K | — | $5K | 2.48% |
| HOLLAND INSURANCE, INC.3 Filed as: HOLLAND INSURANCE INC | PO BOX 328 SOUTHAVEN, MS 38671 | ANTHEM LIFE INSURANCE COMPANY | $15K | — | $15K | 11.74% |
| CORNERSTONE BROKER INS SERVICES3 Filed as: CORNERSTONE BROKER INSURANCE | 2101 FLORENCE AVENUE CINCINNATI, OH 45206 | ANTHEM LIFE INSURANCE COMPANY | $6K | $422 | $6K | 4.96% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE COMPANY | $5K | — | $5K | 3.91% |
| HOLLAND INSURANCE, INC.3 Filed as: HOLLAND INSURANCE INC | PO BOX 328 SOUTHAVEN, MS 38671 | ANTHEM LIFE INSURANCE COMPANY | $13K | — | $13K | 11.25% |
| CORNERSTONE BROKER INS SERVICES3 Filed as: CORNERSTONE BROKER INS SVCS AGENCY | 2102 FLORENCE AVE CINCINNATI, OH 45206 | ANTHEM LIFE INSURANCE COMPANY | $5K | $309 | $6K | 4.91% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 5455 RINGS RD STE 250 DUBLIN, OH 43017 | ANTHEM LIFE INSURANCE COMPANY | $4K | — | $4K | 3.75% |
| HOLLAND INSURANCE, INC.3 Filed as: HOLLAND INSURANCE INC | PO BOX 328 SOUTHAVEN, MS 38671 | STANDARD INSURANCE COMPANY | $10K | — | $10K | 10.78% |
| CORNERSTONE BROKER INS SERVICES3 Filed as: CORNERSTONE BROKER INSURANCE SERVIC | 2101 FLORENCE AVE. CINCINNATI, OH 45206 | STANDARD INSURANCE COMPANY | $5K | $276 | $5K | 4.96% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 3.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 ADMIN/NETWORK PHARMACY | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Float revenue Service code 12 | — | $493K |
| HOLLAND INSURANCE INC BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | PO BOX 328 SOUTHAVEN, MS 38671 | $41K |
| USI INS SERVICES LLC | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $14K |
| USI INSURANCE SERVICES LLC BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 201 ALHAMBRA CIRCLE STE 801 CORAL GABLES, FL 33134 | $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 | 353 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 353 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | COMMUNITY INSURANCE COMPANY | 497 | $183K |
| Vision | COMMUNITY INSURANCE COMPANY | 497 | $183K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 353 | $130K |
| Short-term disability | STANDARD INSURANCE COMPANY | 250 | $97K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 239 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 497 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.