| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUMITY, INC.3 | 5214F DIAMOND HEIGHTS BOULEVARD SUITE 1152 SAN FRANCISCO, CA 94131 | CAREFIRST BLUECHOICE, INC. | $0 | $16K | $16K | 0.87% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $11K | $4K | $15K | 6.34% |
| MATHER & STROHL ADMINISTRATIVE SVCS3 | 15800 CRABBS BRANCH WAY SUITE 350 ROCKVILLE, MD 20855 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $10K | $3K | $14K | 5.88% |
| GIS BENEFITS INC3 Filed as: GIS NORTHERN CALIFORNIA | 315 MONTGOMERY ST SUITE 900 SAN FRANCISCO, CA 94104 | METLIFE LEGAL PLANS | $335 | $0 | $335 | 11.01% |
| SAHOURI INSURANCE AGENCY & ASSOC3 Filed as: SAHOURI INSURANCE AND FINANCIAL INC | 8200 GREENSBORO DR SUITE 1550 MCLEAN, VA 22102 | METLIFE LEGAL PLANS | $226 | $0 | $226 | 7.43% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201 BLDG 1, SUITE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS | $0 | $156 | $156 | 5.13% |
| LUMITY, INC.3 | 5214F DIAMOND HTS BLVD UNIT #1152 SAN FRANCISCO, CA 94131 | METLIFE LEGAL PLANS | $78 | $0 | $78 | 2.56% |
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 | 290 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 296 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CAREFIRST BLUECHOICE, INC. | 435 | $1.9M |
| Dental | CAREFIRST BLUECHOICE, INC. | 435 | $1.9M |
| Vision | CAREFIRST BLUECHOICE, INC. | 435 | $1.9M |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 270 | $234K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 270 | $234K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 270 | $234K |
| Prescription drug | CAREFIRST BLUECHOICE, INC. | 435 | $1.9M |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 270 | $237K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 435 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.