| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | P.O. BOX 632886 CINCINNATI, OH 452632886 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $827 | $13K | $14K | 3.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $9K | $9K | 2.07% |
| NORTHERN INSURANCE SERVICES LTD3 | 350 HOUBOLT ROAD JOLIET, IL 60431 | BLUE CROSS BLUE SHIELD OF ARIZONA | $11K | $350 | $12K | 4.06% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATTI, OH 45263 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $834 | $32 | $866 | 9.73% |
| NORTHERN INS SERVICES3 | 350 HOUBOLT RD JOLIET, IL 60431 | MONY LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 14.99% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BCBS OF ARIZONA | 2444 WEST LAS PALMARITAS DRIVE PHOENIX, AZ 85021 | MONY LIFE INSURANCE COMPANY OF AMERICA | $0 | $348 | $348 | 4.99% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $698 | — | $698 | 15.86% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $190 | — | $190 | 9.99% |
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 | 158 | 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) | 158 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 112 | $745K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 112 | $745K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 112 | $295K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 158 | $22K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 31 | $9K |
| Other(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 155 | $469K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 158 | — |
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.