| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 23514 | HEALTHKEEPERS, INC. | $10K | — | $10K | 1.24% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 203491 DALLAS, TX 75320 | HEALTHKEEPERS, INC. | $7K | — | $7K | 0.95% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 3716 NORFOLK, VA 23514 | DIRECTCARE HMO | $7K | — | $7K | 2.88% |
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 23514 | VISION SERVICE PLAN | $2K | — | $2K | 2.81% |
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 23514 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $907 | — | $907 | 1.28% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 203491 DALLAS, TX 75320 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $694 | — | $694 | 0.98% |
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 23514 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $90 | — | $90 | 1.28% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 203491 DALLAS, TX 75320 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $69 | — | $69 | 0.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHKEEPERS, INC. EIN 54-1356687 | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Other fees Service code 12 | PO BOX 27401 RICHMOND, VA 27401 | $342K |
| ANTHEM HEALTH PLANS OF VIRGINIA EIN 54-0357120 | Float revenue; Claims processing; Other services; Other fees; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | PO BOX 27401 RICHMOND, VA 27401 | $48K |
| ANTHEM HEALTH PLANS OF VIRGINIA 54- | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $0 |
| HEALTHKEEPERS, INC. 54-1356687 | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $0 |
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 | 2,065 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 40 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | HEALTHKEEPERS, INC. | 2,181 | $1.1M |
| Dental | DELTA DENTAL OF VIRGINIA | 3,238 | $880K |
| Vision(5 contracts, 4 carriers) | HEALTHKEEPERS, INC. | 2,181 | $1.2M |
| Prescription drug(4 contracts, 3 carriers) | HEALTHKEEPERS, INC. | 2,181 | $1.1M |
| Stop-loss / reinsurancereinsurance(4 contracts, 3 carriers) | HEALTHKEEPERS, INC. | 2,181 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,238 | — |
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.