| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 3176 NORFOLK, VA 23514 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $9K | $9K | 16.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 62827 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | — | $6K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $972 | $4K | 8.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 3176 NORFOLK, VA 23514 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $7K | $7K | 14.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 62827 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $782 | $7K | 16.94% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62827 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $80 | $2K | 6.82% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | — | $298 | $298 | 0.98% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 3176 NORFOLK, VA 23514 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $3K | $3K | 14.53% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 62827 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 3176 NORFOLK, VA 23514 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $3K | $3K | 14.49% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 62827 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | ATTN MIDWEST PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $227 | $2K | 11.88% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 3176 NORFOLK, VA 23514 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $882 | $882 | 16.70% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | PO BOX 62827 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $528 | — | $528 | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC EIN 35-0781558 TPA/NETWORK PHARMACY | Other commissions; Insurance agents and brokers; Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Non-monetary compensation; Contract Administrator Service code 12 | — | $179K |
| EXPRESS SCRIPTS, INC | Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $51K |
| USI INSURANCE SERVICES, LLC | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $43K |
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 | 891 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 891 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC | 0 | $0 |
| Dental | DELTA DENTAL OF INDIANA | 1,757 | $362K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 1,461 | $30K |
| Life insurance(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 891 | $168K |
| Short-term disability(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 785 | $111K |
| Long-term disability(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 785 | $91K |
| Stop-loss / reinsurancereinsurance | SIHO INSURANCE SERVICES | 0 | $3.9M |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 891 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,757 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.