| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | UNITEDHEALTHCARE INSURANCE COMPANY | $15K | $0 | $15K | 1.54% |
| NAMELY EMPLOYEE BENEFITS, LLC3 Filed as: NAMELY EMPLOYEE BENEFITS LLC | 35 PARKWOOD DRIVE, SUITE 200 HOPINKTON, MA 01748 | UNITEDHEALTHCARE INSURANCE COMPANY | $9K | $0 | $9K | 0.91% |
| BENEFIT MALL3 | 1133 WESTCHESTER AVENUE, SUITE S229 WHITE PLAINS, NY 10604 | UNITEDHEALTHCARE INSURANCE COMPANY | $8K | $0 | $8K | 0.86% |
| NAMELY EMPLOYEE BENEFITS, LLC3 Filed as: NAMELY EMPLOYEE BENEFITS LLC | 195 BROADWAY, FLOOR 15 NEW YORK, NY 10007 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $0 | $7K | 2.77% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $0 | $6K | 2.61% |
| DJA, INC.3 Filed as: DJA INC | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $4K | $5K | 1.97% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $2K | $2K | 0.84% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4069 CHAIN BRIDGE ROAD, TOP FLOOR FAIRFAX, VA 22030 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 13.39% |
| NAMELY EMPLOYEE BENEFITS, LLC3 Filed as: NAMELY EMPLOYEE BENEFITS LLC | 195 BROADWAY, FLOOR 15 NEW YORK, NY 10007 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $714 | $0 | $714 | 5.03% |
| THOMPSON RISK II, LLC3 Filed as: THOMPSON RISK LLC | 2575 NORTHBROOK PLAZA DRIVE UNIT 204 NAPLES, FL 34119 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $225 | $40 | $265 | 1.87% |
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 | 123 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 199 | $948K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $240K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $240K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $240K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $240K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $240K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 199 | $948K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $254K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 294 | — |
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.