| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE CO (G1400) | $4K | — | $4K | 14.50% |
| USI INSURANCE SERVICES LLC3 | 200 W CYPRESS CREEK RD #500 FORT LAUDERDALE, FL 33309 | ANTHEM LIFE INSURANCE CO (G1400) | $1K | $2K | $3K | 13.00% |
| TERESA PROFILET YATES3 Filed as: TERESA PROFILET YATTES | 1350 BANK OF AMERICA CENTER NORFOLK, VA 23510 | ANTHEM LIFE INSURANCE CO (G1400) | — | $33 | $33 | 0.14% |
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 | 99 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE CO (G1400) | 99 | $25K |
| Short-term disability | ANTHEM LIFE INSURANCE CO (G1400) | 99 | $24K |
| Other(2 contracts) | ANTHEM LIFE INSURANCE CO (G1400) | 99 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.