| 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 | $27K | $61K | $88K | 1.34% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | $8K | $22K | 4.87% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $11K | $18K | 3.93% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $11K | 2.32% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, CA 62889 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 1.30% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $990 | $6K | 1.20% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 0.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $807 | $807 | 0.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BUILD-A-BEAR WORKSHOP INC. EIN 59-1031071 CLAIM ADMIN AND RELATED | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Other services; Contract Administrator; Direct payment from the plan Service code 12 | 415 S. 18TH STREET, SUITE 200 ST. LOUIS, MO 63103 | $10K |
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 | 1,580 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,580 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 646 | $6.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 646 | $6.5M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 646 | $6.5M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 934 | $462K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 934 | $462K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 934 | $462K |
| Other(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 934 | $7.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 934 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.