| 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 | $19K | $2K | $21K | 3.10% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $14K | $22 | $14K | 2.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | -$2K | $0 | -$2K | -0.36% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $2K | $153 | $2K | 3.03% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $1K | $2 | $1K | 2.10% |
| GALLAGHER BENEFIT SERVICES, INC.4 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | -$186 | $0 | -$186 | -0.29% |
| USI INSURANCE SERVICES LLC3 | PO BOX 60119 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $0 | $1K | 2.44% |
| USI INSURANCE SERVICES LLC3 | 3190 FAIRVIEW PARK, STE 400 FALLS CHURCH, VA 22042 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $474 | $3K | 10.50% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $899 | $46 | $945 | 3.50% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $412 | $1 | $413 | 1.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | -$70 | $0 | -$70 | -0.26% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 8.52% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 9.69% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $343 | $0 | $343 | 5.83% |
| USI INSURANCE SERVICES LLC3 | 3190 FAIRVIEW PARK, STE 400 FALLS CHURCH, VA 22042 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $192 | $22 | $214 | 16.76% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $60 | $1 | $61 | 5.98% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $49 | $1 | $50 | 4.90% |
| 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 | — | $42K |
| INDEPENDENT FIDUCIARY SERVICES, LLC EIN 82-2870895 TRUSTEE | Trustee (directed) Service code 25 | 8460 TYCO ROAD, SUITE E VIENNA, VA 22182 | $24K |
| CITRIN COOPERMAN & COMPANY LLP EIN 22-2428965 AUDITOR | Accounting (including auditing) Service code 10 | 2 BETHESDA METRO CENTER, 11TH FLOOR BETHESDA, MD 20814 | $17K |
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 | 198 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 110 | $771K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 130 | $58K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 130 | $58K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 189 | $39K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 188 | $33K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 188 | $39K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 188 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 189 | — |
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.