| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $53 | $7K | 5.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | RELIANCE STANDARD | $2K | — | $2K | 3.68% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL BENEFITS, LLC | 40 TIOGA WAY STE 30A MARBLEHEAD, MA 19045 | RELIANCE STANDARD | — | $679 | $679 | 1.19% |
| GROUP BENEFIT SERVICES INC3 | 6 NORTH PARK DRIVE SUITE 310 HUNT VALLEY, MD 21030 | RELIANCE STANDARD | $182 | $137 | $319 | 0.56% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | RELIANCE STANDARD | $1K | — | $1K | 3.67% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL BENEFITS, LLC | 40 TIOGA WAY MARBLEHEAD, MA 19045 | RELIANCE STANDARD | — | $446 | $446 | 1.24% |
| GROUP BENEFIT SERVICES INC3 | 6 NORTH PARK DRIVE SUITE 310 HUNT VALLEY, MD 21030 | RELIANCE STANDARD | $120 | $90 | $210 | 0.59% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | RELIANCE STANDARD | $93 | — | $93 | 3.71% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL BENEFITS, LLC | 40 TIOGA WAY MARBLEHEAD, MA 19045 | RELIANCE STANDARD | — | $36 | $36 | 1.44% |
| GROUP BENEFIT SERVICES INC3 | 6 NORTH PARK DRIVE SUITE 310 HUNT VALLEY, MD 21030 | RELIANCE STANDARD | $7 | $5 | $12 | 0.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SYMETRA FINANCIAL EIN 91-0742147 NONE | Insurance services Service code 23 | — | $593K |
| THE LOOMIS COMPANY EIN 23-2238132 NONE | Other services; Claims processing; Plan Administrator Service code 12 | — | $83K |
| CBIZ EIN 31-1582098 NONE | Insurance agents and brokers; Consulting (general) Service code 16 | — | $48K |
| CIGNA HEALTH & LIFE INSURANCE COMPA EIN 59-1031071 NONE | Other services; Claims processing Service code 12 | — | $27K |
| HINES & ASSOCIATES EIN 36-3545085 NONE | Other services Service code 49 | — | $23K |
| US FIRE INSURANCE COMPANY EIN 13-5459190 NONE | Insurance services Service code 23 | — | $10K |
| JANUS ASSOCIATES, INC. DBA BHS EIN 52-1306404 NONE | Other services Service code 49 | — | $5K |
| ZELIS CLAIMS INTEGRITY, INC. EIN 86-1040704 NONE | Other services Service code 49 | — | $4K |
| EVOLUTIONS HEALTHCARE SYSTEM EIN 59-3139483 NONE | Other services Service code 49 | — | $667 |
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 | 184 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 54 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 238 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 369 | $134K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 219 | $11K |
| Life insurance | RELIANCE STANDARD | 184 | $57K |
| Long-term disability | RELIANCE STANDARD | 183 | $36K |
| Other(2 contracts) | RELIANCE STANDARD | 184 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 369 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.