| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | $0 | $9K | 3.20% |
| GROUP BENEFIT SERVICES INC3 | 6 N PARK DR SUITE 310 HUNT VALLEY, MD 21030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | $0 | $2K | 0.80% |
| USI INSURANCE SERVICES LLC3 | 1750 H ST NW STE 200 WASHINGTON, DC 200064652 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $225 | $3K | 5.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INTEGRATED HR SOLUTIONS, LLC EIN 20-2249765 NONE | Contract Administrator Service code 13 | 2901 CORPORATE CIRCLE 100 FLOWER MOUND, TX 75028 | $32K |
| INDEPENDENT FIDUCIARY SERVICES, LLC EIN 82-2870895 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 | $11K |
| 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 | 177 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $275K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $275K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $275K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $54K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $54K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $54K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $275K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $275K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.