| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTHERN INSURANCE SERVICES LTD3 | 350 HOUBOLT ROAD JOLIET, IL 60431 | BLUE CROSS BLUE SHIELD OF ARIZONA | $22K | $350 | $22K | 3.01% |
| DOW INSURANCE SERVICE INC3 | 1011 STATE SERVICE INC. SUITE 210 LEMONT, IL 60439 | BLUE CROSS BLUE SHIELD OF ARIZONA | $6K | — | $6K | 0.78% |
| NORTHERN INS SERVICES3 | 350 HOUBOLT RD JOLIET, IL 60431 | MONY LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 9.08% |
| DOW INSURANCE SERVICE INC3 | 1011 STATE ST SUITE 210 LEMONT, IL 60439 | MONY LIFE INSURANCE COMPANY OF AMERICA | $990 | — | $990 | 4.92% |
| 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 | — | $939 | $939 | 4.66% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $131 | — | $131 | 1.51% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATTI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $118 | — | $118 | 2.01% |
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 | 174 | 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) | 174 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 174 | $745K |
| Dental | BLUE CROSS BLUE SHIELD OF ARIZONA | 174 | $745K |
| Vision | BLUE CROSS BLUE SHIELD OF ARIZONA | 174 | $745K |
| Life insurance | MONY LIFE INSURANCE COMPANY OF AMERICA | 164 | $20K |
| Short-term disability(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 29 | $15K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 174 | $745K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 27 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.