| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVS LLC | PO BOX 406,75 JOHN ROBERTS RD BLDG C SOUTH PORTLAND, ME 04112 | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. CAREFIRST BLUECHOICE INC. | $28K | $72 | $28K | 3.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC | P.O. BOX 61007 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 11.02% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DR STE 310 HUNT VALLEY, VA 21030 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $309 | $309 | 2.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC | P.O. BOX 61007 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 8.82% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DR STE 310 HUNT VALLEY, MD 21030 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $271 | $271 | 2.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC | P.O. BOX 61007 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 8.98% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DR STE 310 HUNT VALLEY, MD 21030 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $270 | $270 | 2.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC | P.O. BOX 61007 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $457 | — | $457 | 15.87% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DR STE 310 HUNT VALLEY, MD 21030 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $58 | $58 | 2.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCG HR, LLC EIN 20-2249765 NONE | Contract Administrator Service code 13 | 2901 CORPORATE CIRCLE 100 FLOWER MOUND, TX 75028 | $31K |
| PHILIP CHAO EIN 52-1804602 TRUSTEE | Trustee (directed) Service code 25 | 8460 TYCO ROAD, SUITE E VIENNA, VA 22182 | $24K |
| RUBINO & COMPANY CHARTERED EIN 52-1186096 AUDITOR | Accounting (including auditing) Service code 10 | 6903 ROCKLEDGE DRIVE, SUITE 1200 BETHESDA, MD 20817 | $19K |
| BENEFITS CONSULTING GROUP EIN 72-2660473 NONE | Participant communication; Contract Administrator Service code 13 | 2901 CORPORATE CIRCLE 100 FLOWER MOUND, TX 75028 | $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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 164 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. CAREFIRST BLUECHOICE INC. | 129 | $927K |
| Dental | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. CAREFIRST BLUECHOICE INC. | 129 | $927K |
| Vision | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. CAREFIRST BLUECHOICE INC. | 129 | $927K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $16K |
| Short-term disability(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $16K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 147 | $15K |
| Prescription drug | GROUP HOSPITALIZATION MEDICAL SERVICES, INC. CAREFIRST BLUECHOICE INC. | 129 | $927K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 147 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.