| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALPHA OMEGA1 | — | ADVANTICA | $4K | — | $4K | 8.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON BLUE CROSS BLUE SHIELD OF N EIN 22-0999690 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $4.5M |
| TRI-STATE ADMINISTRATORS EIN 22-3478819 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $3.7M |
| O'BRIEN, BELLAND, & BUSHINSKY, LLC EIN 37-1467056 NONE | Legal; Direct payment from the plan Service code 29 | — | $84K |
| SLEVIN & HART, P.C. EIN 52-1708613 NONE | Legal; Direct payment from the plan Service code 29 | — | $70K |
| MORGAN, LEWIS, & BOCKIUS, LLP EIN 23-0891050 NONE | Legal; Direct payment from the plan Service code 29 | — | $68K |
| BOND BEEBE, P.C. EIN 52-1044197 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $51K |
| VISION BENEFITS OF AMERICA EIN 25-1149206 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Plan Administrator; Insurance services; Claims processing Service code 12 | — | $42K |
| CHEIRON INC. EIN 13-4215617 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $15K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 NONE | Other fees; Direct payment from the plan Service code 50 | — | $12K |
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 | 11,579 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 350 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 11,929 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GROUP DENTAL SERVICE OF MARYLAND, INC. | 957 | $153K |
| Vision | ADVANTICA | 1,651 | $47K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 9,176 | $379K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 9,146 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,176 | — |
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.