| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $19K | $19K | 3.95% |
| UMR, INC.3 | 11 SCOTT ST STE 100 WAUSAU, WI 54403 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $3K | $3K | 0.66% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | P.O. BOX 62889 VIRGINIA BEACH, VA 23466 | SUPERIOR DENTAL CARE, INC. | $12K | — | $12K | 4.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 NONE | Direct payment from the plan; Float revenue; Other fees; Claims processing Service code 12 | — | $745K |
| UMR, INC. EIN 39-1995276 NONE | Claims processing Service code 12 | — | $134K |
| USI INSURANCE SERVICES LLC EIN 13-3771734 NONE | Other commissions Service code 55 | — | $67K |
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NONE | Other fees; Non-monetary compensation; Float revenue; Other commissions; Contract Administrator; Claims processing; Insurance brokerage commissions and fees; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $53K |
| WORKTERRA - EBS NONE | Consulting (general); Other services Service code 16 | 5675 GIBRALTAR DRIVE PLEASANTON, CA 94588 | $27K |
| CLARK, SCHAEFER, HACKETT & CO. EIN 31-0800053 NONE | Accounting (including auditing) Service code 10 | — | $9K |
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 | 425 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 425 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | SUPERIOR DENTAL CARE, INC. | 917 | $241K |
| Vision | VISION SERVICE PLAN | 423 | $57K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 446 | $493K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 917 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.