| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | UNITED CONCORDIA INSURANCE COMPANY | $8K | — | $8K | 7.02% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $2K | $16K | 21.36% |
| EBSME LLC3 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $2K | $4K | 4.86% |
| TRIBRIDGE PARTNERS LLC5 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 4.60% |
| EBSME LLC5 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $303 | $303 | 0.40% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $2K | $9K | 17.65% |
| TRIBRIDGE PARTNERS LLC5 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 4.56% |
| EBSME LLC3 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $655 | $2K | $2K | 4.51% |
| EBSME LLC5 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $205 | $205 | 0.40% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $10K | 21.65% |
| EBSME LLC3 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $774 | $2K | $2K | 4.88% |
| TRIBRIDGE PARTNERS LLC5 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 4.60% |
| EBSME LLC5 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $194 | $194 | 0.40% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS | ONE EAST PRATT STREET, SUITE 902 BALTIMORE, MD 21202 | EYEMED | $2K | — | $2K | 8.69% |
| EBSME LLC5 Filed as: EBSME, LLC | P.O. BOX 120 MOUNT AIRY, MD 21771 | EYEMED | — | $1K | $1K | 5.43% |
| KELLY & ASSOCIATES INSURANCE GROUP5 Filed as: KELLY & ASSOCIATES | 1 KELLY WAY SPARKS, MD 21152 | EYEMED | — | $814 | $814 | 3.26% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS, LLC | ONE EAST PRATT STREET, SUITE 902 BALTIMORE, MD 21202 | UNITED HEALTHCARE INSURANCE COMPANY | $864 | — | $864 | 5.00% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $409 | $2K | 17.71% |
| TRIBRIDGE PARTNERS LLC5 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $629 | $629 | 4.60% |
| EBSME LLC3 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $175 | $446 | $621 | 4.54% |
| EBSME LLC5 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $55 | $55 | 0.40% |
| TRIBRIDGE PARTNERS LLC3 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $600 | $127 | $727 | 17.85% |
| TRIBRIDGE PARTNERS LLC5 Filed as: TRIBRIDGE PARTNERS, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $187 | $187 | 4.59% |
| EBSME LLC3 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $52 | $133 | $185 | 4.54% |
| EBSME LLC5 Filed as: EBSME, LLC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $16 | $16 | 0.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ORIEN RISK ANALYSTS, INC. EIN 11-3563729 NONE | Contract Administrator Service code 13 | — | $288K |
| SISCO EIN 42-1144827 NONE | Contract Administrator Service code 13 | — | $86K |
| TRIBRIDGE PARTNERS, LLC EIN 46-1325247 NONE | Contract Administrator Service code 13 | — | $50K |
| CIGNA GREAT WEST HEALTH EIN 84-0467907 NONE | Contract Administrator Service code 13 | — | $37K |
| OPTUMHEALTH MTP - UHIC EIN 52-1996029 NONE | Contract Administrator Service code 13 | — | $17K |
| BENEFIT INDEMNITY CORP. EIN 66-0761417 NONE | Contract Administrator Service code 13 | — | $5K |
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 | 265 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 265 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 369 | $110K |
| Vision | EYEMED | 314 | $25K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $62K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 179 | $76K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $56K |
| Stop-loss / reinsurancereinsurance | FAIR AMERICAN INSURANCE AND REINSURANCE COMPANY | 209 | $276K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 399 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 399 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.