| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST INC. | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNION SECURITY INSURANCE COMPANY | $12K | $5K | $17K | 21.23% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE | 312 ELM ST., 24TH FL CINCINNATI, OH 45202 | DENTAL CARE PLUS, INC. | $3K | — | $3K | 6.51% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE | 312 ELM ST., 24TH FL CINCINNATI, OH 45202 | DENTAL CARE PLUS, INC. | $1K | — | $1K | 6.51% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | 312 ELM ST., 24TH FL CINCINNATI, OH 45202 | COMMUNITY INSURANCE COMPANY | $788 | $2K | $3K | 18.46% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SPECTRUM UNDERWRITING MANAGERS EIN 35-1801164 NONE | Claims processing; Contract Administrator Service code 12 | — | $93K |
| CDBI EIN 82-0563218 NONE | Claims processing; Contract Administrator Service code 12 | — | $48K |
| USI MIDWEST EIN 31-0507943 NONE | Insurance agents and brokers Service code 22 | — | $42K |
| HEALTHSPAN EIN 31-1431434 NONE | Contract Administrator; Claims processing Service code 12 | — | $16K |
| THE SANDSTECH GROUP NONE | Claims processing; Contract Administrator Service code 12 | 1385 KEMPER MEADOW DR. CINCINNATI, OH 45240 | $10K |
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 | 192 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 144 | $14K |
| Dental(3 contracts, 2 carriers) | DENTAL CARE PLUS, INC. | 144 | $76K |
| Vision | COMMUNITY INSURANCE COMPANY | 144 | $14K |
| Life insurance | UNION SECURITY INSURANCE COMPANY | 192 | $79K |
| Short-term disability | UNION SECURITY INSURANCE COMPANY | 192 | $79K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 192 | $79K |
| Other | UNION SECURITY INSURANCE COMPANY | 192 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.