| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 WEST 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | CAREFIRST BLUE CHOICE, INC. | — | $22K | $22K | 3.49% |
| CBIZ BENEFITS & INSURANCE SERVICES5 Filed as: CBIZ M.T. DONAHOE & ASSOCIATES | 9755 PATUXENT WOODS DR., SUITE 250 COLUMBIA, MD 21046 | CAREFIRST BLUE CHOICE, INC. | — | $7K | $7K | 1.14% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $13K | — | $13K | 14.34% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | DOMINION NATIONAL | $3K | — | $3K | 7.48% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $265 | — | $265 | 1.37% |
| JAY E. BLACK3 | 1400 MIDHURST CT BEL AIR, MD 21014 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $110 | — | $110 | 10.26% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $77 | $77 | 7.18% |
| CAMDEN BENEFITS GROUP INC3 | 2300 YORK ROAD, SUITE 106 TIMONIUM, NY 21093 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8 | — | $8 | 0.75% |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CAREFIRST BLUE CHOICE, INC. | 73 | $636K |
| Dental | DOMINION NATIONAL | 82 | $37K |
| Vision | VISION SERVICE PLAN | 68 | $19K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 114 | $90K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 114 | $90K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 114 | $90K |
| Prescription drug | CAREFIRST BLUE CHOICE, INC. | 73 | $636K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 114 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 114 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.