| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF OHIO | — | $636 | $636 | 0.35% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC - MIDWEST | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | — | $15K | 10.36% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $11K | $11K | 7.18% |
| THE SIEKMANN COMPANY3 | 9000 MEMORIAL DR PLAN CITY, OH 43064 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | — | $10K | 6.85% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | — | $1K | 3.15% |
| THE SIEKMANN COMPANY3 | 9000 MEMORIAL DR PLAIN CITY, OH 43064 | VISION SERVICE PLAN | $401 | — | $401 | 1.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NONE | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Contract Administrator Service code 12 | — | $287K |
| USI INSURANCE SERVICES LLC EIN 13-3771734 NONE | Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions; Insurance agents and brokers Service code 22 | — | $22K |
| THE SIEKMANN COMPANY NONE | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 9000 MEMORIAL DR PLAIN CITY, OH 43064 | $6K |
| INGENIORX, INC. EIN 82-3062245 NONE | Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | -$39K |
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 | 326 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 326 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 577 | $180K |
| Vision | VISION SERVICE PLAN | 262 | $37K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 326 | $147K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 326 | $147K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 326 | $147K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 272 | $504K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 326 | $147K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 577 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.