| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $49K | — | $49K | 13.84% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ M T DONAHOE & ASSOCIATES | 9755 PATUXENT WOODS DRIVE STE. 250 COLUMBIA, MD 21046 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $10K | — | $10K | 2.77% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $18K | $5K | $23K | 12.35% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | DOMINION NATIONAL | $4K | — | $4K | 6.56% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINICINNATI, OH 452632886 | DENTAQUEST MID-ATLANTIC, INC. | $2K | — | $2K | 6.04% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $1K | — | $1K | 5.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Insurance agents and brokers; Other insurance fees and expenses Service code 22 | — | $16K |
| CIGNA HEALTH & LIFE INSURANCE CO. | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication; Float revenue; Other services; Non-monetary compensation; Named fiduciary Service code 12 | — | $0 |
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 | 355 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 355 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 223 | $352K |
| Dental(2 contracts, 2 carriers) | DOMINION NATIONAL | 355 | $100K |
| Vision | VISION SERVICE PLAN | 131 | $19K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $189K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $189K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $189K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $189K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 355 | — |
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.