| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS, LLC | 5280 CORPORATE DR SUITE C250 FREDERICK, MD 217038502 | UNITED HEALTHCARE INS. CO. | $4K | $0 | $4K | 8.47% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS | 1 E PRATT ST STE 902 BALTIMORE, MD 21202 | UNITED OF OMAHA LIFE INS. CO. | $1K | $677 | $2K | 16.36% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL BENEFITS | 40 TIOGA WAY STE 230 MARBLEHEAD, MA 01945 | UNITED OF OMAHA LIFE INS. CO. | $0 | $113 | $113 | 1.06% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS | 1 E PRATT ST STE 902 BALTIMORE, MD 21202 | UNITED OF OMAHA LIFE INS. CO. | $2K | $658 | $2K | 21.37% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL BENEFITS | 40 TIOGA WAY STE 230 MARBLEHEAD, MA 01945 | UNITED OF OMAHA LIFE INS. CO. | — | $110 | $110 | 1.06% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS | 1 E PRATT ST STE 902 BALTIMORE, MD 21202 | UNITED OF OMAHA LIFE INS. CO. | $683 | $433 | $1K | 16.33% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL BENEFITS | 40 TIOGA WAY STE 230 MARBLEHEAD, MA 01945 | UNITED OF OMAHA LIFE INS. CO. | — | $72 | $72 | 1.05% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS | 1 E PRATT ST STE 902 BALTIMORE, MD 21202 | UNITED OF OMAHA LIFE INS. CO. | $986 | $408 | $1K | 21.21% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL BENEFITS | 40 TIOGA WAY STE 230 MARBLEHEAD, ME 01945 | UNITED OF OMAHA LIFE INS. CO. | — | $68 | $68 | 1.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAREFIRST ADMIN | Claims processing Service code 12 | 1501 S. CLINTON ST 7TH FLOOR BALTIMORE, MD 21224 | $32K |
| TRIBRIDGE PARTNERS BROKER | Insurance agents and brokers Service code 22 | 1 E PRATT ST SUITE 902 BALTIMORE, MD 21202 | $20K |
| BENECON EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $11K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $3K |
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 | 52 | 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) | 52 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED HEALTHCARE INS. CO. | 97 | $47K |
| Vision | UNITED HEALTHCARE INS. CO. | 97 | $47K |
| Life insurance | UNITED OF OMAHA LIFE INS. CO. | 79 | $11K |
| Long-term disability | UNITED OF OMAHA LIFE INS. CO. | 79 | $10K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE CO. | 52 | $140K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INS. CO. | 79 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 97 | — |
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.