| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | COMMUNITY INSURANCE COMPANY | $28K | — | $28K | 1.99% |
| SHAWAN MARQUIS AGENCY INC3 | 110 EAST WILSON BRIDGE ROAD SUITE 260 COLUMBUS, OH 43085 | COMMUNITY INSURANCE COMPANY | $4K | — | $4K | 0.31% |
| USI INSURANCE SERVICES LLC3 | 1 HILLCREST DRIVE EAST CHARLESTON, WV 25311 | DELTA DENTAL OF OHIO | $7K | — | $7K | 9.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $4K | — | $4K | 6.12% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $825 | — | $825 | 6.25% |
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 | 100 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 100 | $1.4M |
| Dental | DELTA DENTAL OF OHIO | 230 | $73K |
| Vision | VISION SERVICE PLAN | 107 | $13K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY (G1400) | 134 | $67K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY (G1400) | 134 | $67K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY (G1400) | 134 | $67K |
| Other(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY (G1400) | 183 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.