| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 19 EAST 200 SOUTH SALT LAKE CITY, UT 84111 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 6.40% |
| ARDENA L MCVICKER3 Filed as: ARDENA L. MCVICKER | 73 KATYDID LANE MORGANTOWN, PA 19543 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $246 | $2K | 4.50% |
| BRENT L GOODE3 Filed as: BRENT MCVICKER | 73 KATYDID LANE MORGANTOWN, PA 19543 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $923 | $26 | $949 | 2.25% |
| BENECHOICE ENROLLMENT SOLUTIONS3 | 1574 LITITZ PIKE LANCASTER, PA 17601 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $370 | $60 | $430 | 1.02% |
| CUSTOME INS SPECIALISTS INC3 Filed as: CUSTOME INS. SPEC. AND OTHER AGENTS | 886 EAST 3200 NORTH KAMAS, UT 84036 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $311 | $7 | $318 | 0.75% |
| EDWARD P DOUGHERTY INC3 Filed as: EDWARD P. DOUGHERTY, INC. | 4550 PRESTWICK DRIVE READING, PA 19606 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $276 | $0 | $276 | 0.65% |
| CASEY H EBBERT3 Filed as: CASEY H. EBBERT | 1574 LITITZ PIKE LANCASTER, PA 17601 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $255 | $0 | $255 | 0.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | HARTFORD LIFE AND ACCIDENT | $3K | $49 | $3K | 14.03% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | AETNA LIFE INSURANCE COMPANY | $3K | $0 | $3K | — |
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 | 124 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED STATES FIRE INSURANCE | 39 | $377K |
| Dental | AETNA LIFE INSURANCE COMPANY | 187 | $0 |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 179 | $62K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 50 | $42K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 179 | $20K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 128 | $522K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 179 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 187 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.