| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | 312 ELM ST 24TH FL CINCINNATI, OH 45202 | COMMUNITY INSURANCE COMPANY | — | $626 | $626 | 0.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 3176 NORFOLK, VA 235143716 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | $4K | $12K | 14.56% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | PO BOX 3176 NORFOLK, VA 235143716 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $2K | $5K | 16.02% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 203510 NORTH CAROLINA LOCKBOX DALLAS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $143 | — | $143 | 15.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| USI MIDWEST LLC NONE | Non-monetary compensation; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other commissions; Other services; Insurance agents and brokers; Claims processing; Insurance brokerage commissions and fees; Float revenue Service code 12 | 312 ELM ST 24TH FLOOR CINCINNATI, OH 45202 | $264K |
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 | 512 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 512 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | COMMUNITY INSURANCE COMPANY | 546 | $339K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 512 | $79K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 214 | $29K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 546 | $339K |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,168 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,168 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.