| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| QBA BENEFITS LLC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $31K | $0 | $31K | 7.30% |
| USI INSURANCE SERVICES LLC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $13K | $0 | $13K | 3.06% |
| QBA BENEFITS LLC3 | 24610 DETROIT ROAD SUITE 150 WESTLAKE, OH 44145 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $0 | $5K | 4.39% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $0 | $3K | 2.20% |
| NFP INSURANCE SERVICES INC3 | 1250 S CAPITAL OF TEXAS HWY 2-125 AUSTIN, TX 78746 | SUN LIFE ASSURANCE COMPANY OF CANADA | $429 | $0 | $429 | 0.34% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 24610 DETROIT ROAD CLEVELAND, OH 44145 | DELTA DENTAL OF OHIO | $2K | $0 | $2K | 3.46% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF OHIO | $813 | $0 | $813 | 1.21% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $180 | $0 | $180 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 | Contract Administrator Service code 13 | — | $56K |
| CIGNA | Named fiduciary; Claims processing; Non-monetary compensation; Other services; Contract Administrator; Direct payment from the plan; Float revenue; Participant communication Service code 12 | — | $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 | 202 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 209 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 200 | $428K |
| Dental | DELTA DENTAL OF OHIO | 239 | $67K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 213 | $125K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 213 | $125K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 213 | $126K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 239 | — |
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.