| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CIBZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | AETNA LIFE INSURANCE CO. | $0 | $14K | $14K | 2.77% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CIBZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | AETNA LIFE INSURANCE CO. | $0 | -$14K | -$14K | -2.77% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CIBZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | AETNA LIFE INSURANCE CO. | $12K | $0 | $12K | 3.12% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CIBZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | AETNA LIFE INSURANCE CO. | $0 | $5K | $5K | 1.39% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CIBZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | AETNA LIFE INSURANCE CO. | $0 | -$5K | -$5K | -1.39% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | ATTN COMMISSIONS PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $6K | $6K | 2.10% |
| PHILADELPHIA OFFICE, DIRECT BU | 1000 CONTINENTAL DRIVE STE 650 KING OF PRUSSIA, PA 19406 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | ATTN COMMISSIONS PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$3K | $3K | $0 | 0.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $6K | — | $6K | 25.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1166 AVENUE OF THE AMERICAS 22ND FLOOR NEW YORK, NY 10036 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $6K | — | $6K | 25.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | ATTN COMMISSIONS PB BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $311 | $311 | 1.87% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | ATTN COMMISSIONS PO BOX 632886 CINCINNATI, OH 45263 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $62 | $62 | 2.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Other services; Float revenue; Contract Administrator; Named fiduciary; Non-monetary compensation; Claims processing; Participant communication; Direct payment from the plan Service code 12 | — | $832K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 NONE | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication Service code 12 | — | $30K |
| CIGNA | Float revenue; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Participant communication; Contract Administrator; Other services; Claims processing Service code 12 | — | $0 |
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 | 1,114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 205 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,319 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 2,030 | $805K |
| Dental | AETNA LIFE INSURANCE CO. | 2,306 | $504K |
| Vision(2 contracts) | COMBINED INSURANCE COMPANY OF AMERICA | 1,448 | $105K |
| Life insurance | AETNA LIFE INSURANCE CO. | 1,306 | $369K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 131 | $17K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,435 | $273K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 2,030 | $803K |
| Other(7 contracts, 5 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 6,675 | $399K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,675 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.