| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| U S I INSURANCE SERVICES, LLC3 Filed as: U S I INSURANCE SERVICES LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF VIRGINIA | $10K | — | $10K | 3.95% |
| USI INSURANCE SERVICES LLC3 | SUITE 1300 300 E MAIN ST NORFOLK, VA 23510 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 235143716 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $583 | — | $583 | 0.76% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 6050 OAK TREE BOULEVARD CLEVELAND, OH 44131 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 9.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHKEEPERS, INC. EIN 54-1356687 THIRD PARTY ADMINISTRATO | Other fees; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $76K |
| ANTHEM HEALTH PLANS OF VIRGINIA, IN EIN 54-0357120 THIRD PARTY ADMINISTRATO | Other services; Float revenue; Other fees; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $75K |
| AETNA BEHAVIORAL HEALTH, LLC PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVENUE RSAA HARTFORD, CT 06156 | $14K |
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 | 411 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 424 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 609 | $554K |
| Dental | DELTA DENTAL OF VIRGINIA | 637 | $251K |
| Vision(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 609 | $581K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 93 | $77K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 609 | $554K |
| Other(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 93 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 637 | — |
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.