| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62817 VIRGINIA BEACH, VA 23466 | HEALTHKEEPERS, INC. | $19K | — | $19K | 2.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203991 DALLAS, TX 75320 | HEALTHKEEPERS, INC. | $1K | — | $1K | 0.11% |
| BRIAN D. OBAL3 | PO BOX 3427 NORFOLK, VA 23514 | HEALTHKEEPERS, INC. | $696 | — | $696 | 0.07% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62817 VIRGINIA BEACH, VA 23466 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $9K | — | $9K | 2.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203991 DALLAS, TX 75320 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $518 | — | $518 | 0.11% |
| BRIAN D. OBAL3 | PO BOX 3427 NORFOLK, VA 23514 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $343 | — | $343 | 0.07% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE COMPANY | $7K | — | $7K | 8.46% |
| DAVID EMERSON3 Filed as: DAVID C. GOODE | 4880 COX ROAD, SUITE 102 GLEN ALLEN, VA 23060 | ANTHEM LIFE INSURANCE COMPANY | — | $89 | $89 | 0.10% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF VIRGINIA | $4K | — | $4K | 5.38% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 300 EAST MAIN STREET, SUITE 1300 NORFOLK, VA 23510 | AETNA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.73% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 3190 FAIRVIEW PARK DRIVE SUITE 400 FALLS CHURCH, VA 22042 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | — | $2K | 10.99% |
| DANNY R. OSTER3 | 11812 SAWGRASS LANE FREDERICKSBURG, VA 22407 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $929 | — | $929 | 4.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203491 DALLAS, TX 75320 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $36 | — | $36 | 0.16% |
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 | 231 | 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) | 231 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTHKEEPERS, INC. | 115 | $1.4M |
| Dental | DELTA DENTAL OF VIRGINIA | 313 | $80K |
| Life insurance(3 contracts, 3 carriers) | ANTHEM LIFE INSURANCE COMPANY | 231 | $148K |
| Short-term disability(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 231 | $125K |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 231 | $125K |
| Prescription drug(2 contracts, 2 carriers) | HEALTHKEEPERS, INC. | 115 | $1.4M |
| Other(4 contracts, 4 carriers) | ANTHEM LIFE INSURANCE COMPANY | 231 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 313 | — |
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.