| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PSH INSURANCE, INC.3 Filed as: PSH INSURANCE INC. | 737 BISHOP ST., SUITE 2120 HONOLULU, IL 96813 | UNIVERSITY HEALTH ALLIANCE | $13K | — | $13K | 4.92% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | P. O. BOX 632886 CINCINNATI, OH 452632886 | HARTFORD LIFE AND ACCIDENT | $444 | — | $444 | 1.61% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ - MINNEAPOLIS, MN | P. O. BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 11.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD MN EIN 41-0984460 NONE | Contract Administrator; Claims processing; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $47K |
| PRIME THERAPEUTICS | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other fees; Contract Administrator Service code 12 | — | $46K |
| REDPATH & COMPANY, LTD. EIN 41-0975573 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $20K |
| DELTA DENTAL OF MINNESOTA EIN 41-1905554 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $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 | 110 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 58 | $260K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 146 | $272K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 91 | $28K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 91 | $28K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 91 | $28K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 58 | $260K |
| Other | HARTFORD LIFE AND ACCIDENT | 91 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.