| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 203014 DALLAS, TX 75320 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $39K | $3K | $43K | 2.06% |
| EMPLOYEE FAMILY PROTECTION INC3 | PO BOX 1237 GLASTONBURY, CT 06033 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $31K | $5K | $37K | 18.92% |
| USI INSURANCE SERVICES LLC3 | 3190 FAIRVIEW PARK DRIVE, SUITE 400 FALLS CHURCH, VA 22042 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $788 | $8K | 4.17% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 1.59% |
| USI INSURANCE SERVICES LLC3 | 1753 PINNACLE DRIVE, SUITE 800 MCLEAN, VA 22102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $85 | $0 | $85 | 0.04% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES | PO BOX 89662 CHARLOTTE, NC 28289 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $51 | $0 | $51 | 0.03% |
| EMPLOYEE FAMILY PROTECTION INC3 | UNKNOWN WOODBRIDGE, VA 22192 | COMBINED INSURANCE COMPANY OF AMERICA | $18K | $0 | $18K | 18.04% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN WOODBRIDGE, VA 22192 | COMBINED INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 2.79% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 9020 STONY POINT PARKWAY, SUITE 200 RICHMOND, VA 23235 | DOMINION NATIONAL | $6K | $0 | $6K | 6.48% |
| USI INSURANCE SERVICES LLC3 | 4605 COLUMBUS STREET VIRGINIA BEACH, VA 23462 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $456 | $180 | $636 | 12.86% |
No Schedule C service providers reported on this filing.
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 | 285 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 245 | $2.1M |
| Dental | DOMINION NATIONAL | 229 | $97K |
| Vision | METLIFE | 138 | $10K |
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 669 | $198K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 669 | $193K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 245 | $2.1M |
| Other(2 contracts, 2 carriers) | COMBINED INSURANCE COMPANY OF AMERICA | 419 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 669 | — |
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.