| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC-MIDATLANTIC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 1.46% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC-MIDATLANTIC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 1.17% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC-MIDATLANTIC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $824 | — | $824 | 0.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK BLUE CROSS BLUE SHIELD WV NONE | Claims processing; Other services; Plan Administrator Service code 12 | 614 MARKET STREET PARKERSBURG, WV 26101 | $51K |
| UNITED CONCORDIA COMPANIES, INC. NONE | Plan Administrator Service code 14 | P.O. BOX 69420 HARRISBURG, PA 171069420 | $6K |
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 | 151 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $305K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 151 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.