| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SVCES., INC. | 160 WEST SANTA CLARA STREET SUITE 450 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 0.90% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SVCES., INC. | 2421 ATLANTIC AVENUE, SUITE 101 MANASQUAN, NJ 08736 | UNITED HEALTHCARE INSURANCE COMPANY | $17K | — | $17K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SVCES., INC. | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 5.99% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SVCES., INC. | PO BOX 632886 CINCINNATI, OH 45263 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 12.26% |
| LEAVITT GROUP3 Filed as: LEAVITT INSURANCE SERVICES | 1820 EAST 1ST STREET, SUITE 500 SANTA ANA, CA 92705 | SUN LIFE ASSURANCE COMPANY OF CANADA | $356 | — | $356 | 2.08% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SVCES., INC. | PO BOX 632886 CINCINNATI, OH 45263 | EYEMED VISION CARE | $1K | — | $1K | 9.13% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SVCES., INC. | PO BOX 632886 CINCINNATI, OH 45263 | CALIFORNIA DENTAL NETWORK, INC. | $993 | — | $993 | 10.00% |
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 | 363 | 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) | 363 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 230 | $1.3M |
| Dental(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 350 | $112K |
| Vision | EYEMED VISION CARE | 286 | $15K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 350 | $102K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 123 | $17K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 230 | $1.3M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 350 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 350 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.