| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | P O BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | $4K | $24K | 9.83% |
| BUKATY COMPANIES3 | 4601 COLLEGE BLVD SUITE 100 LEAWOOD, KS 66211 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 1.65% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | P O BOX 632886 CINCINNATI, OH 45263 | UNITED HEALTHCARE | $2K | $0 | $2K | 9.07% |
| BUKATY COMPANIES3 | 4601 COLLEGE BLVD SUITE 100 LEAWOOD, KS 66211 | UNITED HEALTHCARE | $649 | $0 | $649 | 2.56% |
| BUKATY COMPANIES3 | 4601 COLLEGE BLVD SUITE 100 LEAWOOD, KS 66211 | UNITED DENTAL CARE OF MISSOURI | $160 | $439 | $599 | 9.94% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 700 WEST 47TH STREET SUITE 1100 KANSAS CITY, MO 64112 | UNITED DENTAL CARE OF MISSOURI | $443 | $0 | $443 | 7.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE EIN 35-1846036 MED & DENT TPA & UR | Contract Administrator; Claims processing Service code 12 | — | $63K |
| AETNA EIN 06-6033492 NETWORK | Contract Administrator Service code 13 | — | $45K |
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 | 335 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 335 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED DENTAL CARE OF MISSOURI | 31 | $6K |
| Vision | UNITED HEALTHCARE | 142 | $25K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 339 | $248K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 339 | $248K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 339 | $248K |
| Stop-loss / reinsurancereinsurance | AETNA | 282 | $616K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 339 | $248K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 339 | — |
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.