| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES, LLC | 75 JOHN ROBERTS ROAD BUILDING C PO BOX 406 SOUTH PORTLAND, ME 04112 | GHMSI/CAREFIRST BLUECHOICE | $96K | $123 | $96K | 3.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF VIRGINIA | $8K | — | $8K | 7.03% |
| KELLY & ASSOCIATES INSURANCE GROUP Filed as: KELLY AND ASSOCIATES | 301 INTERNATIONAL CIRCLE HUNT VALLEY, MD 21030 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $727 | $145 | $872 | 23.98% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES | 57 STREET ROAD SUITE 400 FALLS CHURCH, VA 22042 | WELLNET HEALTHCARE | $13K | $8K | $20K | — |
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 | 402 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 402 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GHMSI/CAREFIRST BLUECHOICE | 402 | $3.2M |
| Dental | DELTA DENTAL OF VIRGINIA | 247 | $108K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 240 | $4K |
| Prescription drug | WELLNET HEALTHCARE | 406 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 406 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.