| 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 | $22K | $3K | $25K | 3.35% |
| AMWINS3 Filed as: AMWINS CONNECT ADMINISTRATORS INC | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $1K | $0 | $1K | 0.17% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $1K | $176 | $2K | 2.72% |
| AMWINS3 Filed as: AMWINS CONNECT ADMINISTRATORS INC | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $83 | $0 | $83 | 0.14% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $0 | $1K | 2.41% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $598 | $76 | $674 | 2.50% |
| AMWINS3 Filed as: AMWINS CONNECT ADMINISTRATORS INC | 6 NORTH PARK DRIVE, SUITE 310 HUNT VALLEY, MD 21030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $34 | $0 | $34 | 0.13% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.27% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $809 | $809 | 4.07% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.99% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $841 | $841 | 4.54% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $791 | — | $791 | 7.94% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $418 | $418 | 4.19% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $0 | $1 | $1 | 0.05% |
| 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 | — | $41K |
| 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 | $23K |
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 | 184 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 184 | 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 | $822K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 128 | $54K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 128 | $54K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 182 | $19K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 118 | $10K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 118 | $20K |
| Other | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 3 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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.