| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $11K | — | $11K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $6K | — | $6K | 8.53% |
| CHRISTOPHER E FISCHER3 Filed as: CHRISTOPHER E. FISCHER | 35035 N NORTH VALLEY PKWY APT 132A PHOENIX, AZ 85086 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $4K | — | $4K | 5.46% |
| SAYO K SAMESHIMA3 Filed as: SAYO K. SAMESHIMA | 1911 W. 85TH AVENUE APT M366 MERRILLVILLE, IN 46410 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $373 | — | $373 | 0.52% |
| KELLY J WARREN3 Filed as: KELLY J. WARREN | 11051 BROADWAY SUITE C CROWN POINT, IL 46307 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $185 | — | $185 | 0.26% |
| DANIEL J KUDRNA3 Filed as: DANIEL J. KUDRNA | 11051 BROADWAY SUITE C CROWN POINT, IN 46307 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $171 | — | $171 | 0.24% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC AGENTS | P.O. BOX 427 COLUMBIA, SC 29202 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $120 | — | $120 | 0.17% |
| ROBERT ALLEN3 | 10752 W. ROWEL RD PEORIA, AZ 85383 | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | $78 | — | $78 | 0.11% |
| APRIL W. NELSON3 | 6121 FOREST HILLS PL PEACHTREE CORNERS, GA 30092 | LEGALSHIELD | $2K | — | $2K | 9.58% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | LEGALSHIELD | $173 | — | $173 | 0.94% |
| WALTER D. WHEELER3 | 740 17TH STREET EVANSTON, WY 82930 | LEGALSHIELD | $29 | — | $29 | 0.16% |
| MARGARET A. GILLIAM3 | 3363 FLAGSTONE TRCE ELLENWOOD, GA 30294 | LEGALSHIELD | $29 | — | $29 | 0.16% |
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 | 494 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 182 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 676 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 440 | $106K |
| Other(3 contracts, 3 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY (AFLAC) | 494 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 494 | — |
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.