| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 323 WEST LAKESIDE AVENUE, SUITE 410 CLEVELAND, OH 44113 | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | $21K | $0 | $21K | 1.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15800 CRABBS BRANCH WAY, SUITE 350 ROCKVILLE, MD 20855 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $0 | $14K | 10.06% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $8K | $8K | 5.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 1.35% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | STARMOUNT LIFE INSURANCE COMPANY | $0 | $5K | $5K | 5.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15800 CRABBS BRANCH WAY, SUITE 350 ROCKVILLE, MD 20855 | STARMOUNT LIFE INSURANCE COMPANY | $3K | $0 | $3K | 3.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | STARMOUNT LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 15800 CRABBS BRANCH WAY, SUITE 350 ROCKVILLE, MD 20855 | UNUM INSURANCE COMPANY | $3K | $0 | $3K | 11.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM INSURANCE COMPANY | $0 | $518 | $518 | 1.82% |
| STEPHANIE J COHEN3 Filed as: STEPHANIE J. COHEN | 4740 CORRIDOR PLACE, SUITE B BELTSVILLE, MD 20705 | UNUM INSURANCE COMPANY | $268 | $13 | $281 | 0.99% |
| POTOMAC BASIN GROUP ASSOCIATES LLC3 Filed as: POTOMAC BASIN GROUP ASSOCIATES | 6500 ROCK SPRING DRIVE, SUITE 500 BETHESDA, MD 20817 | UNUM INSURANCE COMPANY | $127 | $19 | $146 | 0.51% |
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 | 111 | 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) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 183 | $1.2M |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 127 | $88K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 127 | $88K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $135K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $135K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $135K |
| Prescription drug | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 183 | $1.2M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 160 | $164K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 183 | — |
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.