| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 4840 COX ROAD, SUITE 150 GLEN ALLEN, VA 23060 | SENTARA HEALTH | $2K | $0 | $2K | 0.48% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $6K | 11.56% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 3.34% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $851 | $851 | 1.67% |
| ENROLLEASE3 Filed as: DIGITAL INSURANCE AGENCY LLC | UNKNOWN ATLANTA, GA 30339 | UNITED CONCORDIA INSURANCE COMPANY | $3K | $190 | $3K | 7.09% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN NORFOLK, VA 23510 | UNITED CONCORDIA INSURANCE COMPANY | $2K | $150 | $2K | 3.63% |
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 | 123 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SENTARA HEALTH | 28 | $452K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 117 | $46K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $51K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $51K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $51K |
| Prescription drug | SENTARA HEALTH | 28 | $452K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.