| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | CAREFIRST BLUECHOICE | $151K | $123 | $151K | 3.00% |
| GROUP BENEFIT SERVICES INC5 Filed as: GROUP BENEFIT SERVICES | 6 NORTH PARK DRIVE SUITE 310 HUNT VALLEY, MD 21030 | CAREFIRST BLUECHOICE | — | $20K | $20K | 0.40% |
| N C HALBERT III3 Filed as: HALBERT CARMICHAEL JR. | 7731 TERRAVIEW COURT HANOVER, MD 21076 | COMBINED INSURANCE COMPANY OF AMERICA | $25K | — | $25K | 6.95% |
| JOSEPH P CALARCO3 Filed as: JOSEPH APPELBAUM | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | COMBINED INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 2.07% |
| TANEEKA HUGHES3 | 1435 SOUTHERN AVE OXEN HILL, MD 20745 | COMBINED INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 0.91% |
| KIANNA JONAS3 | — | COMBINED INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 0.34% |
| SHARON SIMPSON MCCLENDON3 Filed as: SHARON ANDERSON | — | COMBINED INSURANCE COMPANY OF AMERICA | $771 | — | $771 | 0.22% |
| RICARDO ACEVEDO3 Filed as: RICARDO RIVERA | — | COMBINED INSURANCE COMPANY OF AMERICA | $452 | — | $452 | 0.13% |
| JANIS JEFFREYS3 | 2023 OLD PHILADELPHIA PIKE LANCASTER, PA 17602 | COMBINED INSURANCE COMPANY OF AMERICA | $358 | — | $358 | 0.10% |
| ESIC CORPORATION3 | 38 SOUTH MARKET STREET SUITE 200 FREDERICK, MD 21701 | COMBINED INSURANCE COMPANY OF AMERICA | $242 | — | $242 | 0.07% |
| LINDA W OLGUIN3 Filed as: LINDA R VAZQUEZ | — | COMBINED INSURANCE COMPANY OF AMERICA | $25 | — | $25 | 0.01% |
| JUAN BELTRAN3 | 12431 SW 94TH COURT MIAMI, FL 33617 | COMBINED INSURANCE COMPANY OF AMERICA | $14 | — | $14 | 0.00% |
| JOSEPH A APPELBAUM3 Filed as: JOSEPH A. APPELBALM | 13816 GLEN MILL RD GAITHERSBURG, MD 20850 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 2.78% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | STANDARD INSURANCE COMPANY | $26K | — | $26K | 10.85% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | STANDARD INSURANCE COMPANY | $25K | — | $25K | 10.87% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | STANDARD INSURANCE COMPANY | $20K | — | $20K | 10.91% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $726 | $105 | $831 | 3.35% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES | 6 NORTH PARK DRIVE SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $272 | — | $272 | 1.10% |
| EMPLOYEE BENEFITS CORP OF AMERICA3 Filed as: EMPLOYEE BENEFITS CORPORATION OF AM | 1 PARK WEST CIRCLE SUITE 306-L MIDLOTHIAN, VA 23114 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $56 | — | $56 | 0.23% |
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 | 1,060 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,061 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 2 | $25K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 688 | $312K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 688 | $312K |
| Life insurance | STANDARD INSURANCE COMPANY | 857 | $187K |
| Short-term disability(2 contracts, 2 carriers) | COMBINED INSURANCE COMPANY OF AMERICA | 429 | $597K |
| Long-term disability | STANDARD INSURANCE COMPANY | 846 | $230K |
| Prescription drug | CAREFIRST BLUECHOICE | 1,060 | $5.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,060 | — |
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.