| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | AETNA LIFE INSURANCE CO | — | $7K | $7K | 0.25% |
| HARRIS A KIVITZ3 | 253 STONEWAY LANE MERIOR STATION, PA 19066 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $48K | — | $48K | 13.87% |
| HARRIS A KIVITZ3 | 253 STONEWAY LANE MERIOR STATION, PA 19066 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $18K | — | $18K | 14.83% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $1K | $1K | 1.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $925 | $925 | 1.00% |
| HARRIS A KIVITZ3 | 253 STONEWAY LANE MERIOR STATION, PA 19066 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 13.92% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $127 | $127 | 1.00% |
| HARRIS A KIVITZ3 | 253 STONEWAY LANE MERIOR STATION, PA 19066 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES | Insurance brokerage commissions and fees Service code 53 | — | $181 |
| CBIZ BENEFITS & INSURANCE SERVICES, EIN 31-1582098 BROKER | Insurance brokerage commissions and fees Service code 53 | — | $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 | 227 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 231 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO | 331 | $2.9M |
| Dental | AETNA LIFE INSURANCE CO | 331 | $2.9M |
| Vision | AETNA LIFE INSURANCE CO | 331 | $2.9M |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 227 | $93K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 32 | $13K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 227 | $103K |
| Other(5 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 227 | $594K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 331 | — |
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.