| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | P.O. BOX 3727 NORFOLK, VA 23514 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $387 | $8K | 6.48% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST | P.O. BOX 3727 NORFOLK, VA 23514 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 5.47% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHEAST INC | 555 PLEASANTVILLE ROAD BRIARCLIFF MANOR, NY 10510 | STANDARD INSURANCE COMPANY | — | $586 | $586 | 1.02% |
| KEY BENEFIT ADMINISTRATORS, INC5 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | UNITED HEALTHCARE | $3K | — | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC EIN 35-1450364 NONE | Contract Administrator Service code 13 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $77K |
| USI INSURANCE SERVICES LLC EIN 31-0507943 NONE | Insurance agents and brokers Service code 22 | P.O. BOX 62889 VIRGINIA BEACH, VA 23466 | $52K |
| LUTHERN PREFERRED EIN 35-2034810 NONE | Contract Administrator Service code 13 | P.O. BOX 11588 LOCKBOX U FORT WAYNE, IN 46859 | $14K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NONE | Contract Administrator Service code 13 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $12K |
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 | 248 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 252 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FIDELITY SECURITY LIFE INSURANCE CO. | 249 | $483K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 271 | $185K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 271 | $127K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 271 | $161K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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."
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.