| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MID ATLANTIC BENEFITS GROUP LLC3 | 203 MARKET ST. SUITE 201 HAVRE DE GRACE, MD 21078 | TRANSAMERICA LIFE INSURANCE COMPANY | $312 | $0 | $312 | 2.43% |
| LISA M GROOM3 | 4 REVELSTONE DRIVE NEWARK, DE 19711 | TRANSAMERICA LIFE INSURANCE COMPANY | $178 | $0 | $178 | 1.38% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 350 FIFTH AVENUE, SUITE 3700 NEW YORK, NY 10118 | RELIANCE STANDARD | $363 | $0 | $363 | 11.01% |
| USI INSURANCE SERVICES LLC3 | 350 FIFTH AVENUE, SUITE 3700 NEW YORK, NY 10118 | RELIANCE STANDARD | $463 | $0 | $463 | 14.98% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | EYEMED | $36 | $0 | $36 | 3.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| USI INSURANCE SERVICES, LLC EIN 13-3771734 BROKER | Insurance agents and brokers Service code 22 | — | $8K |
| HIGHMARK OF DELAWARE EIN 51-0020405 ADMIN | Claims processing Service code 12 | — | $5K |
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $3K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $830 |
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 | 81 | 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) | 81 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 0 | $0 |
| Vision | EYEMED | 48 | $1K |
| Life insurance | TRANSAMERICA LIFE INSURANCE COMPANY | 32 | $13K |
| Short-term disability | RELIANCE STANDARD | 81 | $3K |
| Long-term disability | RELIANCE STANDARD | 81 | $3K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 54 | $24K |
| Other | TRANSAMERICA LIFE INSURANCE COMPANY | 32 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 81 | — |
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.