| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 | 18940 N PIMA RD SCOTTSDALE, AZ 85255 | RELIASTAR LIFE INSURANCE COMPANY | — | $38K | $38K | 5.00% |
| STEALTH PARTNER GROUP LLC3 | 18700 N HAYDEN RD STE 405 SCOTTSDALE, AZ 85255 | RELIASTAR LIFE INSURANCE COMPANY | $19K | — | $19K | 2.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFIT AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $6K | $13K | 8.77% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | — | — | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $0 | $0 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST STE 1100 KANSAS, MO 64112 | PRUDENTIAL INSURANCE CO OF AMERICA | $75K | $0 | $75K | — |
| IMG5 | 2960 NORTH MERDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE CO OF AMERICA | $0 | $59 | $59 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $171K |
| CBIZ BENEFITS AND INSURANCE SERVICE EIN 31-1582098 BROKER | Other commissions Service code 55 | — | $53K |
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 | 230 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 230 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 438 | $145K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 438 | $145K |
| Life insurance(7 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 438 | $296K |
| Short-term disability(2 contracts) | PRUDENTIAL INSURANCE CO OF AMERICA | 217 | $229K |
| Long-term disability | PRUDENTIAL INSURANCE CO OF AMERICA | 164 | $72K |
| Other(6 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 228 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 438 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.