| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | $80K | $84K | 2.83% |
| USI INSURANCE SERVICES LLC3 | PO BOX 1040 MERIDEN, CT 06450 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $390 | $7K | $7K | 0.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $10K | $0 | $10K | 5.87% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $0 | $4K | $4K | 2.66% |
| DATIS HR CLOUD INC3 | PO BOX 715019 CINCINNATI, OH 45271 | STANDARD INSURANCE COMPANY | $0 | $2K | $2K | 1.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $9K | $0 | $9K | 18.13% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | STANDARD INSURANCE COMPANY | $0 | $1K | $1K | 2.21% |
| DATIS HR CLOUD INC3 | PO BOX 715019 CINCINNATI, OK 45271 | STANDARD INSURANCE COMPANY | $0 | $715 | $715 | 1.39% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $0 | $335 | $335 | 0.65% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66995 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | $0 | $2K | 9.97% |
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 | 288 | 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) | 288 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 217 | $3.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 217 | $3.0M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 271 | $21K |
| Life insurance | STANDARD INSURANCE COMPANY | 288 | $164K |
| Short-term disability | STANDARD INSURANCE COMPANY | 288 | $164K |
| Long-term disability | STANDARD INSURANCE COMPANY | 288 | $164K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 217 | $3.0M |
| Other(2 contracts) | STANDARD INSURANCE COMPANY | 288 | $216K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.