| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SVCS | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $7K | $63K | $70K | 3.13% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $3K | $11K | 14.33% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $1K | $5K | 13.59% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $1K | $5K | 13.42% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $422 | $1K | 5.82% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ INSURANCE SERVICES, INC | PO BOX 632886 CINCINNATI, OH 45263 | SELMAN CO | $396 | — | $396 | 4.39% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $334 | $123 | $457 | 13.69% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $14 | $43 | $57 | 39.86% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $74 | $2K | — |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | METROPOLITAN LIFE INSURANCE COMPANY | — | $156 | $156 | — |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 452632886 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $74 | $5K | — |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 452632886 | METROPOLITAN LIFE INSURANCE COMPANY | — | $360 | $360 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATION | Named fiduciary; Direct payment from the plan; Contract Administrator; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | — | $4K |
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 | 397 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 397 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 253 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 253 | $2.2M |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 340 | $25K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 397 | $35K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 297 | $78K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 397 | $36K |
| Other(3 contracts, 2 carriers) | SELMAN CO | 59 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 397 | — |
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.