| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ISI OF MARYLAND LLC3 Filed as: ISI OF MARYLAND | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $287 | $2K | 4.06% |
| INSURANCE SOLUTIONS GROUP, INC.3 Filed as: INSURANCE SOLUTIONS INC. | 151 WEST ST. SUITE 303 ANNAPOLIS, MD 21401 | METROPOLITAN LIFE INSURANCE COMPANY | $194 | $106 | $300 | 0.70% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MD 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $294 | $2K | 14.24% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MD 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $205 | $1K | 14.15% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MA 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $809 | $145 | $954 | 14.15% |
| AMWINS5 | 50 WHITECAP DRIVE N. KINGSTON, RI 02852 | EXPRESS SCRIPTS, INC. | $120 | $0 | $120 | 2.52% |
| INSURANCE SOLUTIONS GROUP, INC.5 Filed as: INSURANCE SOLUTIONS | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | EXPRESS SCRIPTS, INC. | $40 | $0 | $40 | 0.84% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MD 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $515 | $97 | $612 | 14.26% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $332 | $0 | $332 | 8.28% |
| INSURANCE SOLUTIONS GROUP, INC.5 Filed as: INSURANCE SOLUTIONS | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $89 | $0 | $89 | 2.22% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $168 | $0 | $168 | 4.99% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD #130 ANNAPOLIS, MD 21401 | ADVANTICA INSURANCE COMPANY | $114 | $0 | $114 | 10.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CMFI (CAREFIRST) EIN 52-1358219 ADMIN | Claims processing Service code 12 | — | $24K |
| ISI OF MARYLAND, LLC BROKER | Insurance agents and brokers Service code 22 | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | $20K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $12K |
| 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 | 54 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 57 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | 2 | $4K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 151 | $43K |
| Vision(2 contracts, 2 carriers) | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 89 | $5K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 44 | $7K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 44 | $13K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 44 | $10K |
| Prescription drug | EXPRESS SCRIPTS, INC. | 2 | $5K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 57 | $129K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 44 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 151 | — |
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.