| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $3K | $6K | 2.91% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $835 | $970 | $2K | 0.91% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $10K | $0 | $10K | 5.83% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES SOUTHWEST | 2711 NORTH HASKELL AVENUE SUITE 2000 DALLAS, TX 75204 | STANDARD INSURANCE COMPANY | $0 | $4K | $4K | 2.57% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | UNUM INSURANCE COMPANY | $1K | $247 | $1K | 10.07% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | UNUM INSURANCE COMPANY | $1K | $213 | $1K | 8.45% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $865 | $50 | $915 | 8.60% |
| LOCKTON COMPANIES, LLC3 | PO BOX 173850 DENVER, CO 80217 | METLIFE LEGAL PLANS | $0 | $15 | $15 | 0.14% |
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 | 339 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 25 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 364 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 35 | $267K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,206 | $46K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 454 | $370K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 454 | $370K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 454 | $370K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 35 | $267K |
| Other(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 454 | $395K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,206 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.