| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $24K | $1K | $25K | 3.24% |
| AMWINS3 Filed as: AMWINS CONNECT ADMINISTRATORS INC | 11350 MCCORMICK RD HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $4K | — | $4K | 0.57% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $1K | $90 | $2K | 2.19% |
| AMWINS4 Filed as: AMWINS CONNECT ADMINISTRATORS INC | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $269 | — | $269 | 0.39% |
| USI INSURANCE SERVICES LLC3 | 3190 FAIRVIEW PARK DR, STE #400 FALLS CHURCH, VA 22042 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | 2.40% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $411 | $301 | $712 | 8.42% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $654 | $2K | 22.26% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $402 | $339 | $741 | 17.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BOON ADMINISTRATIVE SERVICES EIN 33-0449333 THIRD PARTY ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $21K |
| INDEPENDENT FIDUCIARY SERVICES, LLC EIN 82-2870895 TRUSTEE | Trustee (directed) Service code 25 | — | $10K |
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 | 178 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 103 | $841K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 119 | $46K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 119 | $46K |
| Life insurance(3 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 180 | $19K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 111 | $4K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $20K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 180 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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."
No prospect flags tripped on this filing.