| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | $6K | $13K | 13.37% |
| GIBSON INSURANCE AGENCY, INC.3 | 202 SOUTH MICHIGAN STREET SUITE 1400 SOUTH BEND, IN 46601 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $9K | $0 | $9K | 8.48% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 8.33% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11107 FORT WAYNE, IN 46855 | VISION SERVICE PLAN | $420 | $0 | $420 | 2.50% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 4605 COLUMBUS STREET VIRGINIA BEACH, VA 23462 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 11.18% |
| JJ AND DR ENTERPRISES LLC3 Filed as: JJ AND DR ENTERPRISES, LLC | 72057 COUNTY ROAD 17 NEW PARIS, IN 46553 | PRE-PAID LEGAL SERVICES INC., DBA LEGALSHIELD | $135 | $0 | $135 | 8.35% |
| KELLY HALL WIENING3 | 2835 FIR LANE SOUTH BEND, IN 46615 | PRE-PAID LEGAL SERVICES INC., DBA LEGALSHIELD | $111 | — | $111 | 6.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | HARTFORD LIFE AND ACCIDENT | $113 | $40 | $153 | 20.40% |
No Schedule C service providers reported on this filing.
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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 204 | $72K |
| Vision | VISION SERVICE PLAN | 95 | $17K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 111 | $100K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 111 | $100K |
| Other(4 contracts, 4 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 111 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.