| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 4840 COX ROAD, SUITE 150 GLEN ALLEN, VA 23060 | CAREFIRST BLUECHOICE, INC. | $0 | $19K | $19K | 2.73% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD EXECUTIVE PLAZA III, SUITE 1203 BALTIMORE, MD 21030 | CAREFIRST BLUECHOICE, INC. | $0 | $16K | $16K | 2.26% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $669 | $8K | 11.59% |
| USI INSURANCE SERVICES LLC3 | 580 NORTH 4TH STREET, SUITE 400 COLUMBUS, OH 43215 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | -$2K | $0 | -$2K | -3.09% |
| USI INSURANCE SERVICES LLC3 | 180 PARK AVENUE, 1ST FLOOR FLORHAM PARK, NJ 07932 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $0 | $8K | 11.70% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 4.30% |
| USI INSURANCE SERVICES LLC3 | DC METRO OPCO VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.88% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | EYEMED | $1K | $0 | $1K | 10.86% |
| EBSME LLC3 Filed as: EBSME, LLC | PO BOX 120 MOUNT AIRY, MD 21771 | EYEMED | $513 | $0 | $513 | 3.95% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOCIATES | 1 KELLY WAY SPARKS, MD 21152 | EYEMED | $385 | $0 | $385 | 2.96% |
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 | 106 | 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) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CAREFIRST BLUECHOICE, INC. | 162 | $697K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 81 | $68K |
| Vision | EYEMED | 167 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $66K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $66K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $66K |
| Prescription drug | CAREFIRST BLUECHOICE, INC. | 162 | $697K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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.