| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GARY D. JACOBS3 | 11330 LAKEFIELD DRIVE BUILDING 1, SUITE 100 DULUTH, GA 30097 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $43K | $1K | $44K | 2.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 300 EAST MAIN STREET, SUITE 1300 NORFOLK, VA 23510 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $8K | — | $8K | 0.42% |
| GARY D. JACOBS3 | 11330 LAKEFIELD DRIVE BUILDING 1, SUITE 100 DULUTH, GA 30097 | AETNA LIFE INSURANCE COMPANY | $15K | $4K | $19K | 10.37% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3427 NORFOLK, VA 23514 | AETNA LIFE INSURANCE COMPANY | $5K | — | $5K | 2.94% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J. SMITH LANIER AND COMPANY | PO BOX 70 WEST POINT, GA 31833 | AETNA LIFE INSURANCE COMPANY | $2K | — | $2K | 0.98% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J. SMITH LANIER AND COMPANY | 11330 LAKEFIELD DRIVE BUILDING 1, SUITE 100 DULUTH, GA 30097 | DELTA DENTAL OF VIRGINIA | $5K | — | $5K | 3.79% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF VIRGINIA | $2K | — | $2K | 1.23% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J. SMITH LANIER AND COMPANY | PO BOX 70 WEST POINT, GA 31833 | UNITED HEALTHCARE INSURANCE COMPANY | $476 | $297 | $773 | 5.45% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITED HEALTHCARE INSURANCE COMPANY | $233 | — | $233 | 1.64% |
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 | 394 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 395 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 523 | $1.9M |
| Dental | DELTA DENTAL OF VIRGINIA | 374 | $136K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 139 | $14K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 501 | $180K |
| Short-term disability | AETNA LIFE INSURANCE COMPANY | 501 | $180K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 501 | $180K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 523 | $1.9M |
| Other | AETNA LIFE INSURANCE COMPANY | 501 | $180K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 523 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.