| 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 | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | P. O. BOX 632886 KANSAS CITY, KS 66211 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | 222 S 9TH ST STE 1000 MINNEAPOLIS, MN 55402 | STANDARD INSURANCE COMPANY | $791 | — | $791 | 3.17% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ - DUBLIN OH | P. O. BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $935 | — | $935 | 8.29% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ - MINNEAPOLIS, MN | P. O. BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $187 | — | $187 | 1.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRIME THERAPEUTICS | Contract Administrator; Claims processing; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $68K |
| BLUE CROSS BLUE SHIELD MN EIN 41-0984460 NONE | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 12 | — | $25K |
| DELTA DENTAL OF MINNESOTA EIN 41-1852523 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $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 | 114 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 56 | $259K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 135 | $270K |
| Life insurance | STANDARD INSURANCE COMPANY | 124 | $25K |
| Short-term disability | STANDARD INSURANCE COMPANY | 124 | $25K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 56 | $259K |
| Other | STANDARD INSURANCE COMPANY | 124 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.