| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 170 JENNIFER RD STE 130 ANNAPOLIS, MD 21401 | METROPOLITAN LIFE INSURANCE COMPANY | $742 | $0 | $742 | 2.58% |
| ISI OF MARYLAND LLC3 Filed as: ISI OF MARYLAND | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | METROPOLITAN LIFE INSURANCE COMPANY | $638 | $0 | $638 | 2.22% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 22934 THREE NOTCH RD UNIT B CALIFORNIA, MD 20619 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $763 | $0 | $763 | 6.99% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 540 FORT EVANS RD STE 301 LEESBURG, MD 20176 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $552 | $552 | 5.06% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MD 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $547 | $0 | $547 | 5.01% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 22934 THREE NOTCH RD UNIT B CALIFORNIA, MD 20619 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $595 | $0 | $595 | 7.12% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 540 FORT EVANS RD STE 301 LEESBURG, MD 20176 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $416 | $416 | 4.97% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MD 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $409 | $0 | $409 | 4.89% |
| AMWINS5 | 50 WHITECAP DRIVE N. KINGSTON, RI 02852 | EXPRESS SCRIPTS, INC. | $144 | $0 | $144 | 2.40% |
| INSURANCE SOLUTIONS GROUP, INC.5 Filed as: INSURANCE SOLUTIONS | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | EXPRESS SCRIPTS, INC. | $48 | $0 | $48 | 0.80% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 22934 THREE NOTCH RD UNIT B CALIFORNIA, MD 20619 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $420 | $0 | $420 | 7.10% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 540 FORT EVANS RD STE 301 LEESBURG, MD 20176 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $295 | $295 | 4.99% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MA 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $290 | $0 | $290 | 4.90% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $422 | $0 | $422 | 8.29% |
| INSURANCE SOLUTIONS GROUP, INC.5 Filed as: INSURANCE SOLUTIONS | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $113 | $0 | $113 | 2.22% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $143 | $0 | $143 | 5.00% |
| ISI OF MARYLAND LLC3 | 170 JENNIFER RD STE 130 ANNAPOLIS, MD 21401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $132 | $0 | $132 | 6.16% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 22934 THREE NOTCH RD UNIT B CALIFORNIA, MD 20619 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $125 | $0 | $125 | 5.83% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF MARYLAND LLC | 540 FORT EVANS RD STE 301 LEESBURG, MD 20176 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $119 | $119 | 5.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CMFI (CAREFIRST) EIN 52-1358219 ADMIN | Claims processing Service code 12 | — | $17K |
| ISI OF MARYLAND, LLC BROKER | Insurance agents and brokers Service code 22 | 170 JENNIFER RD SUITE 130 ANNAPOLIS, MD 21401 | $14K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $10K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
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 | 39 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 40 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | 2 | $5K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 104 | $29K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 30 | $3K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $6K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $11K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $8K |
| Prescription drug | EXPRESS SCRIPTS, INC. | 2 | $6K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 31 | $100K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.