| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CFA LLC3 Filed as: CFA, LLC | 1501 S. CLINTON ST. BALTIMORE, MD 21224 | SYMETRA LIFE INSURANCE COMPANY | — | $67K | $67K | 2.98% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $20K | — | $20K | 9.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAREFIRST ADMINISTRATORS EIN 52-1187907 THIRD PARTY ADMIN/PBM | Insurance services Service code 23 | — | $11.5M |
| USI INSURANCE SERVICES EIN 56-1882208 BROKER | Insurance agents and brokers Service code 22 | — | $316K |
| CORDIA PARTNERS EIN 45-3491273 ACCOUNTANT | Accounting (including auditing) Service code 10 | — | $163K |
| S. ROBINSON PLAN EMPLOYEE | Employee (plan) Service code 30 | 2050 BALLENGER AVE., STE 400 ALEXANDRIA, VA 22314 | $150K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 NONE | Contract Administrator Service code 13 | — | $85K |
| HEALTH ADVOCATE EIN 36-2167779 OTHER | Other services Service code 49 | — | $66K |
| USI INSURANCE SERVICES NORTHWEST EIN 91-1176315 PHARMACY CONSULTANT | Other fees Service code 99 | — | $50K |
| HUB INTERNATIONAL INSURANCE | Insurance services Service code 23 | 9713 KEY WEST DR. STE 401 ROCKVILLE, MD 20850 | $43K |
| VISION SERVICE PLAN EIN 06-1227840 VISION ADMINISTRATOR | Insurance services Service code 23 | — | $43K |
| APRIO LLP EIN 57-1157523 AUDITOR | Accounting (including auditing) Service code 10 | — | $42K |
| HEALTHSPARQ/MD LIVE MED EIN 35-2486216 NONE | Other fees Service code 99 | 100 SW MARKET ST. PORTLAND, OR 97201 | $28K |
| ZOMOHEALTH, LLC OTHER SERVICES | Other services Service code 49 | 1700 POST OAK BLVD. HOUSTON, TX 77056 | $27K |
| CONIFER HEALTH EIN 23-1728483 HEALTH DATA WAREHOUSE | Other fees Service code 99 | — | $9K |
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 | 2,860 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 74 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,934 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 2,464 | $204K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 2,630 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,630 | — |
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.