| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM STREET, 24TH FL CINCINNATI, OH 45202 | UNITEDHEALTHCARE INSURANCE COMPANY | $13K | — | $13K | 2.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $5K | $11K | 5.54% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 200 SUMMIT LAKE DRIVE STE. 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $961 | — | $961 | 0.50% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNION SECURITY INSURANCE COMPANY | $21K | $6K | $28K | 26.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | ATTN MIDWEST PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $1K | $7K | 11.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTHCARE SERVICES, INC. EIN 41-1289245 NONE | Other services; Claims processing Service code 12 | — | $368K |
| UNUM LIFE INSURANCE COMPANY EIN 01-0278678 NONE | Contract Administrator Service code 13 | — | $21K |
| USI MIDWEST, INC. EIN 31-0507943 NONE | Other commissions Service code 55 | — | $0 |
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 | 932 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 932 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 359 | $193K |
| Life insurance(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 932 | $167K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 932 | $60K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 1,078 | $646K |
| Other(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 932 | $167K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,078 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.