| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CB12 BENEFITS INS. SERVICES | P.O. BOX 632886 CINCINNATI, OH 45263 | STANDARD INSURANCE CO. | $16K | — | $16K | 2.81% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | ATTN COMMISSIONS PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH 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 | — | — | $0 | 0.00% |
| PHILADELPHIA OFFICE, DIRECT BU | 1000 CONTINENTAL DRIVE STE 650 KING OF PRUSSIA, PA 19406 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 16.11% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 401 PLYMOUTH ROAD, STE 200 PLYMOUTH MEETING, PA 19462 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | — | $3K | $3K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | ATTN COMMISSIONS PB BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | — | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | ATTN COMMISSIONS PO BOX 632886 CINCINNATI, OH 45263 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | — | $0 | 0.00% |
| PHILADELPHIA OFFICE, DIRECT BU | 1000 CONTINENTAL DRIVE STE 650 KING OF PRUSSIA, PA 19406 | UNUM LIFE INSURANCE COMPANY OF AMER | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Float revenue; Claims processing; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Participant communication; Other services; Contract Administrator Service code 12 | — | $1.2M |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 NONE | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication Service code 12 | — | $27K |
| CIGNA | Contract Administrator; Employee (plan); Direct payment from the plan; Claims processing; Other services; Participant communication; Named fiduciary; Non-monetary compensation; Float revenue 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 | 1,063 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 375 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,438 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,908 | $1.2M |
| Dental | AETNA LIFE INSURANCE CO. | 676 | $110K |
| Vision(2 contracts) | COMBINED INSURANCE COMPANY OF AMERICA | 1,443 | $76K |
| Life insurance | STANDARD INSURANCE CO. | 1,419 | $565K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,051 | $296K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 1,908 | $829K |
| Other(7 contracts, 5 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 918 | $335K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,908 | — |
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."
No prospect flags tripped on this filing.