| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1 HILLCREST DR E CHARLESTON, WV 25311 | DELTA DENTAL OF OHIO | $920 | $241 | $1K | 1.38% |
| LYDIA C CLARK3 Filed as: LYDIA CLARK | 11882 PINE MEADOW CIR FISHERS, IN 46037 | DELTA DENTAL OF OHIO | $653 | — | $653 | 0.78% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $934 | — | $934 | 3.03% |
| INTERGRITY BENEFIT PARTNERS, INC3 | 11925 E. 65TH STREET, SUITE #5 INDIANAPOLIS, IN 46235 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $917 | — | $917 | 2.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $626 | $529 | $1K | 11.64% |
| LYDIA CHRISTINE CLARK3 | 11925 E 65TH ST STE 5 INDIANAPOLIS, IN 46236 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $367 | — | $367 | 3.70% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NOT RELATED | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $279K |
| USI INS SERVICES LLC NOT RELATED | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 201 ALHAMBRA CIRCLE STE 801 CORAL GABLES, FL 33134 | $29K |
| DELTA DENTAL OF OHIO EIN 31-0685339 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $11K |
| LYDIA CLARK NOT RELATED | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 13233 ASHVIEW DR FISHERS, IN 46038 | $10K |
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 | 407 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 411 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 407 | $84K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 345 | $31K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 349 | $10K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 378 | $549K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 349 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 407 | — |
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."
No prospect flags tripped on this filing.