| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | UNKNOWN ASHBURN, VA 20147 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $47K | $3K | $50K | 29.42% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INS. GROUP INC. | UNKNOWN ASHBURN, VA 20147 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $24K | $24K | 14.04% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $21K | $5K | $26K | 18.76% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF VIRGINIA | $4K | $0 | $4K | 5.18% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 6.21% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN ASHBURN, VA 20147 | LEGAL CLUB OF AMERICA | $1K | $0 | $1K | 33.29% |
| SHEILA L RAITCH3 Filed as: SHEILA L. RAITCH | 5524 LIBER COURT GAINESVILLE, VA 20155 | AFLAC | $87 | $0 | $87 | 5.74% |
| RICHARD JOSEPH ZILLER JR3 | 20115 MUIRFIELD VILLAGE COURT SUITE C ASHBURN, VA 20147 | AFLAC | $78 | $0 | $78 | 5.15% |
| KATHRYN ROBISON ZILLER3 Filed as: KATHRYN ROBINSON ZILLER | 20115 MUIRFIELD VILLAGE COURT ASHBURN, VA 20147 | AFLAC | $38 | $0 | $38 | 2.51% |
| MJ INSURANCE3 Filed as: LAYNE FINANCIAL & VARIOUS AGENTS | 3009 WILMINGTON ROAD, SUITE 100 NEW CASTLE, PA 16105 | AFLAC | $37 | $0 | $37 | 2.44% |
| MICHAEL R MARTIN3 Filed as: MICHAEL R. MARTIN | 32 OLD HICKORY PITTSBORO, NC 27312 | AFLAC | $14 | $0 | $14 | 0.92% |
| ROBERT A ANDERSON3 Filed as: ROBERT A. ANDERSON | 13710 GENERAL GEARY COURT FREDERICKSBURG, VA 22407 | AFLAC | $11 | $0 | $11 | 0.73% |
| DAVID SCHENKEL JR3 Filed as: DAVID SCHENKEL JR. | 4000 BLACKBURN LANE, SUITE 260 BURTONSVILLE, MD 20866 | AFLAC | $10 | $0 | $10 | 0.66% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $165 | $22 | $187 | 17.00% |
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 | 140 | 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) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 133 | $170K |
| Dental | DELTA DENTAL OF VIRGINIA | 174 | $80K |
| Vision | VISION SERVICE PLAN | 100 | $18K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 144 | $138K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 144 | $138K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 144 | $138K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 133 | $170K |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 144 | $144K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.