| 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 STATES, INC. | $50K | $5K | $55K | 2.34% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | $2K | $21K | 14.45% |
| EFP INC5 Filed as: EFP ADMIN LLC | PO BOX 1237 GLASTONBURY, CT 06033 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $417 | $417 | 0.29% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 9020 STONY POINT PARKWAY SUITE 200 RICHMOND, VA 23235 | DOMINION NATIONAL | $8K | $0 | $8K | 7.02% |
| EMPLOYEE FAMILY PROTECTION INC3 | PO BOX 1237 GLASTONBURY, CT 06033 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $644 | $5K | 30.02% |
| CUSTOM BENEFITS PROGRAMS3 Filed as: CUSTOM BENEFITS PROGRAMS INC | 1 NORTH WHITE HORSE PIKE, SUITE 2 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $262 | $946 | $1K | 7.78% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $917 | $67 | $984 | 6.34% |
| USI INSURANCE SERVICES LLC3 | 1753 PINNACLE DRIVE, SUITE 800 MCLEAN, VA 22102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.05% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: A MARCH & MCGRIFF | SUITE 1800 GREENSBORO, NC 27409 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $605 | $302 | $907 | 15.00% |
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 | 331 | 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) | 331 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | 247 | $2.4M |
| Dental | DOMINION NATIONAL | 238 | $108K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 242 | $146K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 331 | $167K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 242 | $146K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | 247 | $2.4M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 242 | $152K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 331 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.