| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | P O BOX 62889 VIRGINIA BEACH, VA 23466 | AETNA LIFE INSURANCE COMPANY | $8K | $3K | $11K | 5.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC. | P O BOX 3716 NORFOLK, VA 235143716 | VISION SERVICE PLAN | $2K | — | $2K | 4.04% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 9.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 SERVICE PROVIDER | Float revenue; Claims processing; Other fees; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $357K |
| USI MIDWEST LLC SERVICE PROVIDER | Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 312 ELM STREET 24TH FLOOR CINCINNATI, OH 45202 | $76K |
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 | 534 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 552 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE COMPANY | 669 | $214K |
| Vision | VISION SERVICE PLAN | 254 | $43K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 459 | $14K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 721 | $357K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 721 | — |
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.