| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVCIES LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $9K | $87K | $96K | 3.05% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $3K | $31K | $34K | 1.08% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $3K | $3K | 0.10% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVCIES LLC | 1750 H STREET NW, SUITE 200 WASHINGTON, DC 20006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | $831 | $17K | 9.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVCIES LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $644 | $13K | 7.21% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVCIES LLC | 1787 SENTRY PARKWAY WEST VEVA 16 BLUE BELL, PA 19422 | VISION SERVICE PLAN | $3K | $0 | $3K | 9.98% |
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 | 500 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 500 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 284 | $3.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 284 | $3.2M |
| Vision | VISION SERVICE PLAN | 262 | $32K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 500 | $180K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 500 | $180K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 500 | $180K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 284 | $3.2M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 500 | $180K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 500 | — |
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.