| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYEE BENEFITS CORP OF AMERICA3 Filed as: EMPLOYEE BENEFITS CORP. OF AMERICA | 1430 SPRING HILL ROAD, SUITE 320 MCLEAN, VA 22102 | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | $25K | $3K | $28K | 3.15% |
| THE BUSINESS BENEFITS GROUP, INC.3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $5K | $18K | 14.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LLP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.69% |
| THE BUSINESS BENEFITS GROUP, INC.3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | DELTA DENTAL OF VIRGINIA | $7K | $0 | $7K | 7.04% |
| DJA, INC.3 Filed as: DJA INC | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | PRINCIPAL LIFE INSURANCE COMPANY | $862 | $120 | $982 | 6.82% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | PRINCIPAL LIFE INSURANCE COMPANY | $365 | $0 | $365 | 2.53% |
| THE BUSINESS BENEFITS GROUP, INC.3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | HARTFORD ACCIDENT AND LIFE INSURANCE COMPANY | $76 | $0 | $76 | 7.04% |
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 | 153 | 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) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 122 | $892K |
| Dental | DELTA DENTAL OF VIRGINIA | 225 | $97K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 196 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $123K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $123K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $123K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 225 | — |
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.