| 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 | $11K | — | $11K | 1.70% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 328 VIRGINIA BEACH, VA 23466 | COMMUNITY INSURANCE COMPANY | $4K | — | $4K | 0.57% |
| HOLLAND INSURANCE, INC.3 Filed as: HOLLAND INSURANCE INC | PO BOX 328 SOUTHAVEN, MS 38671 | ANTHEM LIFE INSURANCE COMPANY | $33K | — | $33K | 11.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE COMPANY | $11K | $2K | $13K | 4.24% |
| CORNERSTONE BROKER INS SERVICES3 Filed as: CORNERSTONE BROKER INSURANCE | 2101 FLORENCE AVENUE CINCINNATI, OH 45206 | ANTHEM LIFE INSURANCE COMPANY | — | $11K | $11K | 3.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 ADMIN/NETWORK PHARMACY | Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $244K |
| HOLLAND INSURANCE INC | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $32K |
| USI INS SERVICES LLC | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $14K |
| INGENIORX, INC. EIN 82-3062245 ADMIN | Float revenue; Claims processing; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | -$46K |
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 | 259 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 259 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | COMMUNITY INSURANCE COMPANY | 433 | $639K |
| Vision | COMMUNITY INSURANCE COMPANY | 433 | $639K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 259 | $300K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 259 | $300K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 259 | $300K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 433 | $639K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 433 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.