| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $1K | $360 | $2K | 2.73% |
| 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 | $72 | $0 | $72 | 0.11% |
| USI INSURANCE SERVICES LLC3 | 3190 FAIRVIEW PARK DR, STE #400 FALLS CHURCH, VA 22042 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $0 | $1K | 2.60% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.47% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $618 | $618 | 3.07% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 11.16% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $536 | $536 | 2.99% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 61007 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $791 | $0 | $791 | 7.83% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $316 | $316 | 3.13% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 11350 MCCORMICK ROAD, STE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $360 | $120 | $480 | 7.83% |
| 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 | $19 | $0 | $19 | 0.31% |
| 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 | — | $37K |
| INDEPENDENT FIDUCIARY SERVICES, LLC EIN 82-2870895 TRUSTEE | Trustee (directed) Service code 25 | — | $24K |
| CITRIN COOPERMAN & COMPANY LLP EIN 22-2428965 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $16K |
| CITRIN COOPERMAN ADVISORS LLC EIN 87-2525370 TAX RETURN PREPARER | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $6K |
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 | 140 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 145 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 98 | $804K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 123 | $44K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 123 | $44K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 173 | $18K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 115 | $10K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 115 | $20K |
| Other | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 0 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.