| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 6100 FAIRVIEW ROAD SUITE 1400 14TH FLOOR CHARLOTTE, NC 28210 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $16K | — | $16K | 1.83% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 6100 FAIRVIEW ROAD SUITE 1400, 14TH FLOOR CHARLOTTE, NC 28210 | HEALTHKEEPERS, INC. | $15K | — | $15K | 1.83% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | P.O. BOX 203510 DALLAS, TX 75320 | AETNA LIFE INSURANCE CO. | $42K | — | $42K | 15.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 203491 DALLAS, TX 753203491 | DELTA DENTAL OF VIRGINIA | $14K | — | $14K | 8.34% |
| VIRGINIA AUTOMOBILE DEALERS SVCS.3 Filed as: VIRGINIA AUTOMOBILE DEALERS SE | PO BOX 5407 RICHMOND, VA 23220 | DELTA DENTAL OF VIRGINIA | $1K | — | $1K | 0.83% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | 580 N. 4TH STREET SUITE 400 COLUMBUS, OH 43215 | GUARDIAN | $4K | — | $4K | 9.99% |
| VIRGINIA AUTOMOBILE DEALERS SVCS.3 Filed as: VIRGINIA AUTOMOBILE DEALER | 1800 W. GRACE STREET P.O. BOX 5407 RICHMOND, VA 23220 | GUARDIAN | $363 | — | $363 | 1.03% |
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 | 300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 303 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 215 | $1.7M |
| Dental | DELTA DENTAL OF VIRGINIA | 433 | $169K |
| Vision(3 contracts, 3 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 242 | $1.7M |
| Life insurance | AETNA LIFE INSURANCE CO. | 436 | $277K |
| Short-term disability | AETNA LIFE INSURANCE CO. | 436 | $277K |
| Long-term disability | AETNA LIFE INSURANCE CO. | 436 | $277K |
| Other | AETNA LIFE INSURANCE CO. | 436 | $277K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 436 | — |
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."
No prospect flags tripped on this filing.