| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | CIGNA HEALTH AND LIFE INSURANCE CO | $3K | $45K | $47K | 4.14% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE CO | $541 | $9K | $10K | 0.86% |
| USI INSURANCE SERVICES LLC3 | NORTHEAST DB O.O. BOX 62939 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE CO | — | $1K | $1K | 0.10% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE CO | $7K | — | $7K | 7.48% |
| USI INSURANCE SERVICES LLC3 | DC METRO OPCO VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE CO | $2K | — | $2K | 2.54% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | EYEMED | $717 | — | $717 | 6.64% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | EYEMED | $362 | — | $362 | 3.35% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | MONUMENTAL LIFE INSURANCE CO | $202 | — | $202 | 22.82% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | EYEMED | $21 | — | $21 | 5.08% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | EYEMED | $17 | — | $17 | 4.12% |
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 | 155 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE CO | 130 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO | 130 | $1.1M |
| Vision(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE CO | 159 | $1.2M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE CO | 153 | $92K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE CO | 153 | $92K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE CO | 153 | $92K |
| Other | UNITED OF OMAHA LIFE INSURANCE CO | 153 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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.
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.