| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ | 222 S NINTH ST #1000 MINNEAPOLIS, MN 55402 | BCBSM | — | $2K | $2K | 0.55% |
| PSH INSURANCE, INC.3 Filed as: PSH INSURANCE | 737 BISHOP STREET, SUITE 2120 HONOLULU, HI 96813 | UNIVERSITY HEALTH ALLIANCE | $8K | — | $8K | 4.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMPREHENSIVE CARE SERVICES, INC. EIN 41-1427596 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $97K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $40K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $23K |
| TELADOC EIN 04-3705970 NONE | Direct payment from the plan; Other fees Service code 50 | — | $10K |
| ALLIANCE BENEFIT GROUP EIN 41-1737003 NONE | Claims processing; Direct payment from the plan; Recordkeeping fees Service code 12 | — | $9K |
| DELTA DENTAL OF MINNESOTA EIN 41-1905554 NONE | Claims processing 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 | 419 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 423 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 53 | $160K |
| Vision | UNIVERSITY HEALTH ALLIANCE | 53 | $160K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 220 | $19K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 53 | $160K |
| Stop-loss / reinsurancereinsurance | BCBSM | 402 | $329K |
| Other | HARTFORD LIFE AND ACCIDENT | 220 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 402 | — |
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.