| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV | 700 W 47TH ST STE 1100 KANSAS CITY, MO 64112 | FIRST UNUM LIFE INSURANCE COMPANY | — | $613 | $613 | 1.16% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERVICE | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $869 | — | $869 | 6.49% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV | 2421 ATLANTIC AVE MANASQUAN, NJ 08736 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV | 700 W 47TH ST STE 1100 KANSAS CITY, MO 64112 | FIRST UNUM LIFE INSURANCE COMPANY | — | $188 | $188 | 2.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMINISTRATOR | Non-monetary compensation; Float revenue; Claims processing; Other services; Contract Administrator; Direct payment from the plan; Participant communication; Named fiduciary Service code 12 | — | $130K |
| CBIZ BENEFITS & INSURANCE SRVC(OH) BROKER | Insurance brokerage commissions and fees Service code 53 | PO BOX 632886 CINCINNATI, OH 45263 | $87K |
| CIGNA | Other services; Direct payment from the plan; Contract Administrator; Participant communication; Float revenue; Named fiduciary; Non-monetary compensation; 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 | 99 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH & LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 97 | $123K |
| Vision | VISION SERVICE PLAN | 98 | $13K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 97 | $62K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 99 | $45K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 97 | $53K |
| Other(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 97 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.