| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARIO ELOY ROIZ3 Filed as: MARIO E. ROIZ | 10446 NW 31ST TER DORAL, FL 33172 | CAREFIRST BLUECHOICE, INC | $5K | $51K | $56K | 3.98% |
| KELLY & ASSOCIATES INSURANCE GROUP5 | 1 KELLY WAY SPARKS, MD 21152 | CAREFIRST BLUECHOICE, INC | — | $22K | $22K | 1.55% |
| MARIO ELOY ROIZ3 Filed as: MARIO E ROIZ HR BENEFITS SERVICES | 10446 NW 31ST TER FL 2 DORAL, FL 33172 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $630 | $3K | 7.98% |
| KELLY & ASSOCIATES INSURANCE GROUP3 | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| MARIO ELOY ROIZ3 Filed as: MARIO E ROIZ | 10446 NW 31ST TER FL 2 DORAL, FL 33172 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $427 | $2K | 13.49% |
| KELLY & ASSOCIATES INSURANCE GROUP5 Filed as: KELLY & ASSOCIATES INS GROUP INC | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $613 | $613 | 5.01% |
| MARIO ELOY ROIZ3 Filed as: MARIO E ROIZ | 10446 NW 31ST TER FL 2 DORAL, FL 33172 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $945 | $4K | $5K | 48.09% |
| KELLY & ASSOCIATES INSURANCE GROUP5 Filed as: KELLY & ASSOCIATES INS GROUP INC | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $473 | $473 | 5.00% |
| MARIO ELOY ROIZ3 Filed as: MARIO E ROIZ | 10446 NW 31ST TER FL 2 DORAL, FL 33172 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $812 | $279 | $1K | 13.43% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY & ASSOCIATES INSURANCE GROUP, | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $406 | $406 | 5.00% |
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 | 260 | 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) | 260 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CAREFIRST BLUECHOICE, INC | 252 | $1.4M |
| Dental | CAREFIRST BLUECHOICE, INC | 252 | $1.4M |
| Vision | CAREFIRST BLUECHOICE, INC | 252 | $1.4M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $41K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $20K |
| Prescription drug | CAREFIRST BLUECHOICE, INC | 252 | $1.4M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.