| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERVICE | PO BOX 632886 CINCINNATI, OH 45236 | HORIZON HEALTHCARE SERVICES, INC. | $75K | — | $75K | 3.40% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 18.91% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 160 W SANTA CLARA ST STE 675 SAN JOSE, CA 95113 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERVICE | PO BOX 632886 CINCINNATI, OH 45236 | DELTA DENTAL OF NEW JERSEY, INC | $4K | — | $4K | 35.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERVICE | PO BOX 632886 CINCINNATI, OH 45236 | HORIZON INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $426 | $2K | 19.25% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | PRINCIPAL LIFE INSURANCE COMPANY | $36 | — | $36 | 8.87% |
| DONALD C SAVOY INC3 | ROUND TABLE STUDIOS 200 CONNELL DR STE 1000 BERKELEY HEIGHTS, NJ 07922 | PRINCIPAL LIFE INSURANCE COMPANY | — | $17 | $17 | 4.19% |
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 | 163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HORIZON HEALTHCARE SERVICES, INC. | 113 | $2.2M |
| Dental | DELTA DENTAL OF NEW JERSEY, INC | 228 | $11K |
| Vision | HORIZON INSURANCE COMPANY | 124 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $40K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 2 | $406 |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 16 | $26K |
| Prescription drug | HORIZON HEALTHCARE SERVICES, INC. | 113 | $2.2M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.