| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | HM LIFE INSURANCE COMPANY | $120K | — | $120K | 15.00% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | HARTFORD LIFE AND ACCIDENT | $6K | $21K | $28K | 6.50% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | HARTFORD LIFE AND ACCIDENT | $16K | $15K | $31K | 10.25% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | HARTFORD LIFE AND ACCIDENT | $444 | — | $444 | 2.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAREFIRST - KELLY EIN 52-1385894 NONE | Insurance agents and brokers; Claims processing; Insurance services; Contract Administrator Service code 12 | — | $915K |
| DELTA DENTAL - KELLY EIN 23-1667011 NONE | Claims processing; Contract Administrator; Insurance agents and brokers; Insurance services Service code 12 | — | $113K |
| VSP - KELLY EIN 23-7089668 NONE | Insurance agents and brokers; Contract Administrator; Claims processing Service code 12 | — | $28K |
| KELLY - HARTFORD EIN 52-1066374 NONE | Insurance services Service code 23 | — | $0 |
| NASCO EIN 58-1767730 NONE | Contract Administrator Service code 13 | — | $0 |
| TOTAL ADMINISTRATIVE SERVICES EIN 39-1561025 NONE | Contract Administrator; Insurance services Service code 13 | — | $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 | 1,456 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,462 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,456 | $304K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,439 | $424K |
| Other(3 contracts, 2 carriers) | HM LIFE INSURANCE COMPANY | 1,456 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,456 | — |
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.