| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 ATTN MIDWEST VIRGINIA BEACH, VA 23466 | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | $91K | $0 | $91K | 2.61% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF KENTUCKY | $5K | $0 | $5K | 2.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | MIDWEST KENTUCKY OPCO PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | $15K | $30K | 19.41% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | MIDWEST KENTUCKY OPCO PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $8K | $16K | 19.00% |
| USI INSURANCE SERVICES LLC3 | MIDWEST KENTUCKY OPCO PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $4K | $10K | 17.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | MIDWEST KENTUCKY OPCO PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 16.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENECOM COMPANY EIN 20-3767480 THIRD PARTY ADMINISTRATOR | Plan Administrator; Claims processing Service code 12 | 3429 STONY SPRING CIRCLE LOUISVILLE, KY 40220 | $0 |
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 | 916 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | 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) | 923 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 544 | $3.5M |
| Dental | DELTA DENTAL OF KENTUCKY | 638 | $185K |
| Vision | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 544 | $3.5M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 923 | $118K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 481 | $154K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 481 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 923 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.