| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1 HILLCREST DR E CHARLESTON, WV 25311 | DELTA DENTAL PLAN OF OHIO | $37K | — | $37K | 8.04% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 234662889 | RELIASTAR LIFE INSURANCE COMPANY-LI | $17K | — | $17K | 7.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 234662889 | RELIASTAR LIFE INSURANCE COMPANY-LI | $17K | — | $17K | 6.84% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 234662889 | RELIASTAR LIFE INSURANCE COMPANY-ADD/LTD | $12K | — | $12K | 7.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 234662889 | RELIASTAR LIFE INSURANCE COMPANY-ADD/LTD | $11K | — | $11K | 6.83% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 234662889 | RELIASTAR LIFE INSURANCE COMPANY-STD | $11K | — | $11K | 7.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 234662889 | RELIASTAR LIFE INSURANCE COMPANY-STD | $10K | — | $10K | 6.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing; Other services Service code 12 | — | $176K |
| USI INSURANCE SERVICES LLC EIN 31-1440175 | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 201 ALHAMBRA CIRCLE STE 801 CORAL GABLES, FL 33134 | $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 | 654 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 654 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 1,052 | $989K |
| Dental | DELTA DENTAL PLAN OF OHIO | 1,077 | $459K |
| Vision | COMMUNITY INSURANCE COMPANY - VISION | 932 | $61K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY-LI | 778 | $249K |
| Short-term disability | RELIASTAR LIFE INSURANCE COMPANY-STD | 455 | $151K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY-ADD/LTD | 778 | $165K |
| Prescription drug | COMMUNITY INSURANCE COMPANY | 1,052 | $989K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 1,052 | $989K |
| Other | RELIASTAR LIFE INSURANCE COMPANY-ADD/LTD | 778 | $165K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,077 | — |
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.