| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $25K | $0 | $25K | 2.53% |
| USI INSURANCE SERVICES LLC3 | 7 EAST CONGRESS STREET, SUITE 1002 SAVANNAH, GA 31401 | DELTA DENTAL INSURANCE COMPANY | $8K | $0 | $8K | 1.45% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $19K | $19K | 5.79% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $14K | $14K | 4.16% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 15.00% |
| USI INSURANCE SERVICES LLC3 | 2400 EAST COMMERCIAL, SUITE 600 FORT LAUDERDALE, FL 33308 | FEDERAL INSURANCE COMPANY | $2K | $535 | $3K | 18.98% |
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 | 580 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 581 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 138 | $983K |
| Dental | DELTA DENTAL INSURANCE COMPANY | 1,111 | $522K |
| Vision | VISION SERVICE PLAN | 504 | $72K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 817 | $330K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 817 | $330K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 138 | $983K |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,030 | $383K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,030 | — |
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.