| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE RD, STE 170 ROCKVILLE, MD 20850 | STANDARD INSURANCE COMPANY | $8K | $0 | $8K | 15.00% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE RD, STE 170 ROCKVILLE, MD 20850 | STANDARD INSURANCE COMPANY | $3K | $0 | $3K | 15.00% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE RD, STE 170 ROCKVILLE, MD 20850 | GUARDIAN LIFE INSURANCE COMPANY | $0 | $579 | $579 | 6.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SYMETRA FINANCIAL EIN 91-0742147 N/A | Insurance services Service code 23 | — | $330K |
| CAREFIRST ADMINISTRATORS EIN 52-1187907 TPA | Consulting (general) Service code 16 | — | $58K |
| POTOMAC INSURANCE INC EIN 52-1841481 N/A | Insurance agents and brokers Service code 22 | — | $58K |
| CONNECT YOUR CARE EIN 26-1274092 N/A | Claims processing Service code 12 | — | $1K |
| CONIFER VALUE-BASED CLAIMS EIN 52-1964905 N/A | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $1K |
| HEALTHSPARQ EIN 35-2486216 N/A | Other services Service code 49 | — | $653 |
| WESTPORT INSURANCE CORPORATION EIN 48-0921045 N/A | 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 | 144 | 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) | 144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY | 125 | $9K |
| Life insurance | STANDARD INSURANCE COMPANY | 144 | $20K |
| Long-term disability | STANDARD INSURANCE COMPANY | 144 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 144 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.