| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC INC | 1445 RESEARCH BOULEVARD SUITE 210 ROCKVILLE, MD 20850 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | $59K | $143 | $59K | 3.62% |
| ALAN J ZUCCARI INC3 | 4100 MONUMENT CORNER DRIVE SUITE 500 FAIRFAX, VA 22030 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | $23K | $4 | $23K | 1.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC, INC | 9713 KEY WEST AVENUE, SUITE 401 ROCKVILLE, MD 20874 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $9K | 19.85% |
| JAY E. BLACK3 Filed as: JAY E BLACK | 1400 MIDHURST COURT BEL AIR, MD 21014 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 6.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC, INC | 9713 KEY WEST AVENUE, SUITE 401 ROCKVILLE, MD 20874 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $139 | $3K | 6.03% |
| KAREN LINDER-STAUBS3 | 2510 PROCTOR LANE BALTIMORE, MD 21234 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 5.47% |
| ANN MARIE BENT3 | 7551 ORCHID HAMMOCK DRIVE WEST PALM BEACH, FL 33412 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $223 | $0 | $223 | 0.51% |
| SONIA A VIDAL-AWBREY3 | 2665 PROSPERITY AVENUE APARTMENT 113 FAIRFAX, VA 22031 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $223 | $0 | $223 | 0.51% |
| JAY E. BLACK3 Filed as: JAY E BLACK | 1400 MIDHURST COURT BEL AIR, MD 21014 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 4.25% |
| KAREN LINDER-STAUBS3 | 2510 PROCTOR LANE BALTIMORE, MD 21234 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 4.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC, INC | 9713 KEY WEST AVENUE, SUITE 401 ROCKVILLE, MD 20874 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $149 | $2K | 4.02% |
| ANN MARIE BENT3 | 7551 ORCHID HAMMOCK DRIVE WEST PALM BEACH, FL 33412 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $24 | $0 | $24 | 0.06% |
| SONIA A VIDAL-AWBREY3 | 2665 PROSPERITY AVENUE APARTMENT 113 FAIRFAX, VA 22031 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $24 | $0 | $24 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC, INC | 9713 KEY WEST AVENUE, SUITE 401 ROCKVILLE, MD 20874 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 20.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC, INC | 9713 KEY WEST AVENUE, SUITE 401 ROCKVILLE, MD 20874 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 19.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC, INC | 9713 KEY WEST AVENUE, SUITE 401 ROCKVILLE, MD 20874 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $724 | $2K | 15.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC, INC | 9713 KEY WEST AVENUE, SUITE 401 ROCKVILLE, MD 20874 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $740 | $3K | 20.99% |
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 | 229 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 229 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 465 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | 227 | $1.6M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 226 | $36K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 70 | $24K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 225 | $47K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | 227 | $1.6M |
| Other(3 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 226 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 227 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.