| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INC. | 1 KELLY WAY SPARKS, MD 211529484 | UNITED HEALTHCARE INSURANCE COMPANY | $43K | — | $43K | 3.52% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INC. | 1 KELLY WAY SPARKS, MD 211529484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $909 | $3K | 13.80% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INC. | 1 KELLY WAY SPARKS, MD 211529484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $941 | $999 | $2K | 8.25% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INC. | 1 KELLY WAY SPARKS, MD 211529484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $500 | $2K | 14.09% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INC. | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $452 | $2K | 13.70% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY BENEFITS SERVICES | 1 KELLY WAY SPARKS, MD 21152 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 14.00% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INC. | 1 KELLY WAY SPARKS, MD 211529484 | DELTA DENTAL OF PENNSYLVANIA | $711 | — | $711 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NETWORK ADMINISTRATORS D/B/A GSA EIN 11-3335620 ADMIN SUPPORT SERVICES | Direct payment from the plan Service code 50 | 888 VETERANS MEMORIAL HWY SUITE 540 HAUPPAUGE, NY 11788 | $47K |
| FRYE & COMPANY, CPAS EIN 45-4199441 PLAN AUDITOR | Accounting (including auditing) Service code 10 | 9161 LIBERIA AVENUE SUITE 304 MANASSAS, VA 20110 | $15K |
| DELTA DENTAL OF PENNSYLVANIA EIN 23-1667011 CLAIMS ADMINISTRATION | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication; Float revenue; Other services; Non-monetary compensation; Named fiduciary Service code 12 | 1 DELTA DR MECHANICSBURG, PA 170556999 | $7K |
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 | 188 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 122 | $1.2M |
| Dental | DELTA DENTAL OF PENNSYLVANIA | 167 | $0 |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 118 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $24K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $36K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 146 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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.