| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 63286 CINCINNATI, OH 45263 | BLUE CROSS AND BLUE SHIELD OF LOUISIANA | $68K | — | $68K | 3.50% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | $2K | $18K | 17.00% |
| DARIN POTTS3 Filed as: DARIN K. POTTS | 100 DETERING ST., UNIT 2128 HOUSTON, TX 77007 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $5K | $5K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | DELTA DENTAL INSURANCE COMPANY | $11K | — | $11K | 12.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $604 | $5K | 17.00% |
| DARIN POTTS3 Filed as: DARIN K. POTTS | 100 DETERING ST., UNIT 2128 HOUSTON, TX 77007 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $474 | $4K | 17.00% |
| DARIN POTTS3 Filed as: DARIN K. POTTS | 100 DETERING ST., UNIT 2128 HOUSTON, TX 77007 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 5.00% |
| DARIN POTTS3 Filed as: DARIN K. POTTS | 100 DETERING ST., UNIT 2128 HOUSTON, TX 77007 | UNUM INSURANCE COMPANY | $6K | — | $6K | 29.56% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | UNUM INSURANCE COMPANY | $1K | $239 | $2K | 7.94% |
| DARIN POTTS3 Filed as: DARIN K. POTTS | 100 DETERING ST., UNIT 2128 HOUSTON, TX 77007 | UNUM INSURANCE COMPANY | $6K | — | $6K | 34.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | UNUM INSURANCE COMPANY | $1K | $199 | $2K | 9.24% |
| DARIN POTTS3 Filed as: DARIN K. POTTS | 100 DETERING ST., UNIT 2128 HOUSTON, TX 77007 | UNUM INSURANCE COMPANY | $5K | — | $5K | 33.28% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | UNUM INSURANCE COMPANY | $1K | $219 | $1K | 9.46% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | STARMOUNT LIFE INSURANCE COMPANY | $642 | $257 | $899 | 7.00% |
| DARIN POTTS3 Filed as: DARIN K. POTTS | 100 DETERING ST., UNIT 2128 HOUSTON, TX 77007 | STARMOUNT LIFE INSURANCE COMPANY | — | $642 | $642 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ESI EMPLOYEE ASSISTANCE GROUP EIN 22-2762686 EAP PROVIDER | Other services Service code 49 | — | $6K |
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 | 243 | 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) | 243 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF LOUISIANA | 209 | $1.9M |
| Dental | DELTA DENTAL INSURANCE COMPANY | 271 | $95K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 187 | $13K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 243 | $137K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 243 | $107K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 42 | $24K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF LOUISIANA | 209 | $1.9M |
| Other(5 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 243 | $189K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.