| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE | 312 ELM STREET 24TH FLOOR CINCINNATI, OH 45202 | DENTAL CARE PLUS, INC. | $3K | — | $3K | 6.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $365 | $3K | 7.14% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE | 312 ELM STREET 24TH FLOOR CINCINNATI, OH 45202 | DENTAL CARE PLUS, INC. | $2K | — | $2K | 6.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $411 | $3K | 16.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CUSTOM DESIGN BENEFITS EIN 82-0563218 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $51K |
| USI MIDWEST EIN 31-0507943 NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $34K |
| HEALTHSPAN EIN 31-1431434 NONE | Other fees; Direct payment from the plan Service code 50 | — | $29K |
| GLOBAL CARE EIN 31-1407689 NONE | Other fees; Direct payment from the plan Service code 50 | — | $2K |
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 | 227 | 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) | 227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 2 carriers) | DENTAL CARE PLUS, INC. | 62 | $69K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 227 | $42K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 95 | $18K |
| Stop-loss / reinsurancereinsurance | ZURICH AMERICAN INSURANCE COMPANY | 227 | $396K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 227 | — |
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.