| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC (CLEVELEAND) | 8561 MARKET ST YOUNGSTOWN, OH 44512 | COVENTRY HEALTH CARE OF KANSAS, INC. | $15K | — | $15K | 3.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC (CLEVELAND) | 8561 MARKET ST YOUNGSTOWN, OH 44512 | COVENTRY HEALTH AND LIFE | $11K | — | $11K | 3.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | 245 N WACO SUITE 300 WICHITA, KS 67202 | BLUE CROSS AND BLUE SHIELD OF KANSAS | $3K | — | $3K | 5.71% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | CARMEN SIEGRIST 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | VCP SERVICES, INC DBA VISION CARE DIRECT | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICE LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $216 | $2K | 11.53% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF GREATER KANSAS INC | 245 N WACO STE 300 WICHITA, KS 67202 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $298 | $2K | 12.33% |
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 | 552 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 552 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COVENTRY HEALTH CARE OF KANSAS, INC. | 74 | $874K |
| Dental | BLUE CROSS AND BLUE SHIELD OF KANSAS | 210 | $53K |
| Vision | VCP SERVICES, INC DBA VISION CARE DIRECT | 135 | $21K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 552 | $27K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 552 | $14K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 552 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 552 | — |
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.