| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | DELTA DENTAL OF MINNESOTA | $6K | — | $6K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 7.55% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 WEST 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 5.00% |
| AUSMAN BRIDGET3 Filed as: AUSMAN, BRIDGET | 1086 HOWARD STREET SAN FRANCISCO, CA 94103 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $902 | — | $902 | 3.00% |
| GROVE, MARC, A3 | 25900 AUTUMN WAY ROGERS, MN 55374 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 13.71% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 10.03% |
| SMITH, THOMAS, CHRISTOPHER3 | P.O. BOX 6650 METAIRIE, LA 70009 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $754 | $48 | $802 | 4.42% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 WEST 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $78 | $78 | 0.43% |
| GROVE, MARC, A3 | 25900 AUTUMN WAY ROGERS, MN 55374 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 24.16% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 12.70% |
| SMITH, THOMAS, CHRISTOPHER3 | P.O. BOX 6650 METAIRIE, LA 70009 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $279 | — | $279 | 2.35% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 WEST 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $55 | $55 | 0.46% |
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 | 222 | 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) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MINNESOTA | 144 | $60K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 241 | $30K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 33 | $12K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 241 | $30K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 241 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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.