Form 5500 · Employee benefit plan · ASHBURN, VA
INFINITIVE
The filing calls this plan INFINITIVE, INC. HEALTH & WELFARE PLAN.
INFINITIVE of ASHBURN, VA insures vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through UNITED OF OMAHA LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 86-1126700 · plan 506 · plan year 2024, filed Jun 4, 2025
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
The filing carries code 4S: this plan is filing again after previously being exempt.
Benefits declared on this filing
2 contracts on this filing do not say which benefits they cover, so a line above may be insured by one of them.
Also declared: prepaid legal, death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering vision, life and disability; the largest, with UNITED OF OMAHA LIFE INSURANCE COMPANY, covers 77 people.
The filing declares vision, life, disability, health and dental. Health and dental appear with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on one of the 2 contracts here that do not say what they cover.
Reported premium across the insured contracts is $73,839, with $10,735 in disclosed broker commissions — about 15% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICES LLC is the broker of record on 3 of the 4 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 77 | Jan 1, 2025 | $60,876 | $9,131 |
| VISION SERVICE PLAN | Vision | 55 | Jan 1, 2025 | $10,394 | $753 |
| AFLAC | — | 2 | Jan 1, 2025 | $1,813 | $537 |
| LEGAL CLUB OF AMERICA | — | 5 | Jan 1, 2025 | $756 | $314 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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