| 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 | $28K | $7K | $35K | 2.85% |
| DJA, INC.3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $0 | $10K | 5.59% |
| THE BUSINESS BENEFITS GROUP, INC.3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $7K | $7K | 4.01% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INS. SERVICES, LLC | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 1.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 1.78% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INS. SERVICES, LLC | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.12% |
| PATRIOT GROWTH INSURANCE SERVICES3 | BUSINESS BENEFITS GROUP FAIRFAX, VA 22030 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $221 | $0 | $221 | 3.30% |
| DURWOOD BOOTH JR3 | 2900 WILLIAMSBURG TERRACE APARTMENT M204 PLATTE CITY, MO 64079 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $108 | $0 | $108 | 1.61% |
| MULLANEY ENTERPRISES LLC3 Filed as: MULLANEY ENTERPRISES, LLC | 5501 TWIN KNOLLS ROAD, SUITE 106 COLUMBIA, MD 21045 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $70 | $0 | $70 | 1.04% |
| GEG W. WOOLLEY3 | 15492 CLIFFVIEW DRIVE MONTCLAIR, VA 22025 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $0 | $17 | 0.25% |
| MARKS BENEFIT MANAGEMENT LLC3 Filed as: MARKS BENEFIT MANAGEMENT, LLC | 3847 EAST SPYGLASS HILL DRIVE FAYETTEVILLE, AR 72701 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8 | $0 | $8 | 0.12% |
| JOHN E CUMMINGS3 Filed as: JOHN E. CUMMINGS AND OTHERS | 1239 OCEAN SHORE BOULEVARD APARTMENT 5 ORMOND BEACH, FL 32176 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8 | $0 | $8 | 0.12% |
| STEPHEN ROSS WEINSTOCK3 | 1821 MACTAVISH AVENUE RICHMOND, VA 23230 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.06% |
| JAMIE TREPANIER4 | 5114 WOODMERE DRIVE, APARTMENT 304 CENTREVILLE, VA 20120 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $95 | $0 | $95 | 3.07% |
| PATRIOT GROWTH INSURANCE SERVICES4 Filed as: PATRIOT GROWTH INS. SERVICES, LLC | 4069 CHAIN BRIDGE ROAD FAIRFAX, VA 22030 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $78 | $0 | $78 | 2.52% |
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 | 139 | 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) | 140 | 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 | 308 | $1.2M |
| Dental | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 308 | $1.2M |
| Vision(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 308 | $1.2M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $172K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $172K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $172K |
| Prescription drug | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 308 | $1.2M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $181K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 308 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.