| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | 222 RIVERSIDE PLAZA SUITE 630 CHICAGO, IL 60606 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $9K | $9K | 1.79% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM STREET, 24TH FL CINCINNATI, OH 45202 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 1.33% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM STREET, 24TH FL CINCINNATI, OH 45202 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 2.08% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM STREET, 24TH FL CINCINNATI, OH 45202 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 7.08% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | CINCINNATI, OH, ATTN MIDWEST DIRECT PO BOX 62889 VIRGINIA BEACH, VA 23466 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 10.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM STREET, 24TH FL CINCINNATI, OH 45202 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 16.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NONE | Claims processing; Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services Service code 12 | — | $279K |
| USI MIDWEST, LLC EIN 31-0507943 NONE | Insurance agents and brokers; Non-monetary compensation; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $42K |
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 | 254 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 251 | $217K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 452 | $25K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 254 | $156K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 254 | $66K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 226 | $490K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 254 | $156K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 452 | — |
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.