| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM BLUE CROSS AND BLUE SHIELD | $0 | $3K | $3K | 0.15% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | DELTA DENTAL OF WISCONSIN | $61K | — | $61K | 55.54% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $3K | $7K | 17.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 18.59% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 17.49% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 17.40% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - MOUNT | PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $3K | 17.18% |
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 | 228 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 228 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS AND BLUE SHIELD | 200 | $2.0M |
| Dental | DELTA DENTAL OF WISCONSIN | 143 | $110K |
| Vision | ANTHEM BLUE CROSS AND BLUE SHIELD | 200 | $2.0M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 228 | $52K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 228 | $52K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 75 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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.