| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| POTOMAC INSURANCE INC3 Filed as: POTOMAC INSURANCE | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $10K | — | $10K | 3.68% |
| EBCA5 Filed as: EBCA GENERAL AGENCY | 1410 SPRING HILL ROAD SUITE 150 MCLEAN, VA 22102 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $4K | — | $4K | 1.35% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| POTOMAC INSURANCE INC3 | 15825 SHADY GROVE ROAD SUITE 170 ROCKVILLE, MD 20850 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
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 | 55 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 55 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 41 | $266K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 55 | $23K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 55 | $15K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 41 | $266K |
| Other(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 55 | $289K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 55 | — |
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.