| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC5 | MIDATLANTIC PO BOX 61007 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $476 | $476 | 1.57% |
| USI INSURANCE SERVICES LLC5 | MIDATLANTIC PO BOX 61007 VIRGINIA BEACH, VA 23466 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $335 | $335 | 1.56% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | COMPANION LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | COMPANION LIFE INSURANCE COMPANY | — | $168 | $168 | 1.44% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | COMPANION LIFE INSURANCE COMPANY | — | $83 | $83 | 1.60% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | MUTUAL OF OMAHA INSURANCE COMPANY | $263 | — | $263 | 15.02% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $25 | $25 | 1.43% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $20 | $20 | 1.63% |
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 | 106 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 159 | $58K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 159 | $58K |
| Life insurance(5 contracts, 3 carriers) | COMPANION LIFE INSURANCE COMPANY | 58 | $18K |
| Short-term disability(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 74 | $30K |
| Long-term disability(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 90 | $21K |
| Other(3 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 58 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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.