| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HILB GROUP OF NEW ENGLAND3 Filed as: HILB GROUP OF MARYLAND | 3601 MACCORKLE AVE SE #50 CHARLESTOWN, WV 25304 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $830 | $2K | 12.63% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OPERATING CO | 6802 PARAGON PL STE 200 RICHMOND, VA 23230 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $870 | $870 | 5.91% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOC INS GRP INC | 1 KELLY WAY SPARKS, MD 21152 | PRINCIPAL LIFE INSURANCE COMPANY | $163 | $0 | $163 | 1.11% |
| HILB GROUP OF NEW ENGLAND3 Filed as: HLB GROUP OF MARYLAND | 3601 MACCORKLE AVE STE 50 CHARLESTON, WV 25304 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| HILB GROUP OF NEW ENGLAND3 Filed as: HLB GROUP OF MARYLAND | 204 CATOCTIN CIRCLE SE LEESBURG, VA 20175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $647 | $647 | 4.59% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INSURANCE | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $179 | $179 | 1.27% |
| HILB GROUP OF NEW ENGLAND3 Filed as: HLB GROUP OF MARYLAND | 3601 MACCORKLE AVE STE 50 CHARLESTON, WV 25304 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.01% |
| HILB GROUP OF NEW ENGLAND3 Filed as: HLB GROUP OF MARYLAND | 204 CATOCTIN CIRCLE SE LEESBURG, VA 20175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $372 | $372 | 5.19% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INSURANCE | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $87 | $87 | 1.21% |
| HILB GROUP OF NEW ENGLAND3 Filed as: HILB GROUP OF MARYLAND | 118 EDENDERRY AVE CENTREVILLE, MD 21617 | EYE MED | $84 | $0 | $84 | 2.89% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY BENEFIT STRATEGIES | 1 KELLY WAY SPARKS, MD 21152 | EYE MED | $36 | $0 | $36 | 1.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INSURANCE SOLUTIONS (HILB GR) BROKER | Insurance agents and brokers Service code 22 | 540 FORT EVANS RD NE STE 301 LEESBURG, VA 20176 | $19K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $12K |
| MERITAIN HEALTH EIN 16-1264154 CARRIER | Claims processing Service code 12 | — | $6K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
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 | 40 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 41 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 71 | $15K |
| Vision | EYE MED | 47 | $3K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 21 | $7K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 33 | $14K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 41 | $149K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 33 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 71 | — |
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.