| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $56K | — | $56K | 3.15% |
| AP BENEFIT ADVIOSRS LLC3 | 10 N PARK DR #200 HUNT VALLEY, MD 21030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | — | $10K | 0.56% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC. | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $1K | $14K | 9.44% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 N PARK DR STE 200 HUNT VALLEY, MD 21030 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 1.68% |
| EMPLOYEE BENEFITS CORP OF AMERICA3 Filed as: EMPLOYEE BENEFITS CORP. OF AMERICA | 1430 SPRING HILL RD MCLEAN, VA 22102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 0.73% |
| MULTIPLE BROKERS (SEE APPENDIX)3 | PO BOX 427 COLUMBIA, SC 29202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10K | — | $10K | 26.31% |
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 | 346 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 348 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 296 | $1.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 296 | $1.8M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 296 | $1.8M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 346 | $145K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 346 | $145K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 346 | $145K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 296 | $1.8M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 346 | $183K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 346 | — |
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.