| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $26K | $26K | 2.97% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - DAVID | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | DELTA DENTAL OF INDIANA | $4K | $1K | $5K | 10.04% |
| JA BENEFITS LLC - JEFF NEAL3 | PO BOX 159 BEDFORD, IN 47421 | DELTA DENTAL OF INDIANA | $1K | — | $1K | 2.56% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES MIDWEST | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $856 | $3K | 15.14% |
| JA BENEFITS LLC3 | 1630 H STREET BEDFORD, IN 47421 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $826 | — | $826 | 3.89% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC MIDWEST | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $621 | $2K | 15.05% |
| JA BENEFITS LLC3 | 1630 H STREET BEDFORD, IN 47421 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $613 | — | $613 | 4.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC MIDWEST | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $644 | $2K | 15.27% |
| JA BENEFITSS LLC3 | 1630 H STREET BEDFORD, IN 47421 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $603 | — | $603 | 3.94% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC MIDWEST | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $653 | $2K | 15.57% |
| JA BENEFITS LLC3 | 1630 H STREET BEDFORD, IN 47421 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $572 | — | $572 | 4.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - DAVID | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | DELTA DENTAL OF INDIANA | $585 | — | $585 | 7.37% |
| JA BENEFITS, LLC - JEFF NEAL3 | PO BOX 159 BEDFORD, IN 47421 | DELTA DENTAL OF INDIANA | $200 | — | $200 | 2.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 ADMINISTRATOR | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services Service code 12 | — | $35K |
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 119 | $876K |
| Dental | DELTA DENTAL OF INDIANA | 138 | $48K |
| Vision | DELTA DENTAL OF INDIANA | 130 | $8K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $29K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 67 | $21K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $15K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 138 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.