| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | UNITED HEALTHCARE INSURANCE COMPANY | $44K | $907 | $45K | 3.32% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $4K | $6K | 10.21% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $6K | 12.50% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASOCIATES INSURANCE GROUP | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 11.80% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $536 | — | $536 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED OF OMAHA EIN 47-0322111 NONE | Contract Administrator; Claims processing Service code 12 | — | $4K |
| FIDELITY SECURITY LIFE - KELLY ADM EIN 43-0949844 NONE | Insurance services Service code 23 | — | $0 |
| KELLY & ASSOCIATES - UNITED ADMIN EIN 52-1066374 NONE | Insurance services Service code 23 | — | $0 |
| METROPOLITAN LIFE - KELLY ADMIN EIN 13-5581829 NONE | Insurance services Service code 23 | — | $0 |
| UNITED OF OMAHA LIFE INSURANCE EIN 47-0322111 NONE | Insurance services Service code 23 | — | $0 |
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 | 130 | 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) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 113 | $1.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 106 | $63K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 73 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $48K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $51K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 130 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.