| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 11440 TOMAHAWK CREEK PARKWAY LEAWOOD, KS 66211 | KEYSTONE HEALTH PLAN CENTRAL | $9K | — | $9K | 1.62% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVENUS TREVOS, PA 19053 | KEYSTONE HEALTH PLAN CENTRAL | $5K | — | $5K | 0.82% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV | 700 W 47TH STREET STE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $17K | — | $17K | 10.00% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVENUE TREVOSE, PA 19053 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $3K | $17K | 11.81% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | — | $15K | 10.09% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVENUE TREVOSE, PA 19053 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $2K | $14K | 11.94% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | — | $12K | 9.96% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTIN INC | 3160 TREMONT AVENUE TREVOSE, PA 19053 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $5K | 6.88% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVS INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 5.09% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVENUE TREVOSE, PA 19053 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $5K | 7.11% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC. | PO BOX 632886 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 5.04% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 401 PLYMOUTH MEETING ROAD SUITE 200 PLYMOUTH MEETING, PA 19462 | VISION BENEFITS OF AMERICA | $2K | — | $2K | 4.17% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING, INC. | 3160 TREMONT AVENUE TREVOSE, PA 19053 | VISION BENEFITS OF AMERICA | $442 | — | $442 | 0.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $240K |
| UNITED CONCORDIA COMPANIES INC EIN 25-1687586 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $23K |
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 | 417 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 424 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION BENEFITS OF AMERICA | 439 | $53K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 447 | $68K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 444 | $118K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 444 | $145K |
| Prescription drug | CAPITAL ADVANTAGE INSURANCE COMPANY | 49 | $114K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 463 | $234K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.