| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 4840 COX RD STE 150 GLEN ALLEN, VA 23060 | UNITEDHEALTHCARE INSURANCE COMPANY | $5K | $23K | $28K | 4.39% |
| SIMA BENEFITS CONSULTING GROUP3 Filed as: SIMA BENEFITS CONSULTING GROUP LLC | PO BOX 31658 RICHMOND, VA 23294 | UNITEDHEALTHCARE INSURANCE COMPANY | $785 | $0 | $785 | 0.12% |
| USI INSURANCE SERVICES LLC3 | 312 ELM ST FL 24 CINCINNATI, OH 45202 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $354 | $354 | 0.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL IN | PO BOX 203491 DALLAS, TN 75320 | HARTFORD LIFE AND ACCIDENT | $1K | $0 | $1K | 4.70% |
| USI INSURANCE SERVICES LLC3 | ENTERPRISE LICENSING CENTER 601 UNION ST SUITE 1000 SEATTLE, WA 98101 | HARTFORD LIFE AND ACCIDENT | $0 | $557 | $557 | 2.56% |
| SIMA BENEFITS CONSULTING GROUP3 Filed as: SIMA BENEFITS CONSULTING GROUP LLC | PO BOX 31658 RICHMOND, VA 23294 | HARTFORD LIFE AND ACCIDENT | $460 | $0 | $460 | 2.11% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $458 | $0 | $458 | 2.10% |
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 | 83 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 93 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 133 | $634K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 133 | $634K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 129 | $22K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 129 | $22K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 133 | $634K |
| Other | HARTFORD LIFE AND ACCIDENT | 129 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 133 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.