| 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 | $11K | $122K | $132K | 3.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $316 | $2K | 5.09% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 19 EAST 200 SOUTH STE 1000 SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 19 EAST 200 SOUTH STE 1000 SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 19 EAST 200 SOUTH STE 1000 SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 452632886 | HARTFORD ACCIDENT & LIFE INSURANCE | $210 | — | $210 | 4.37% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 19 E 200 SOUTH STE 1000 SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $280 | — | $280 | 10.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 19 EAST 200 SOUTH STE 1000 SALT LAKE CITY, UT 84111 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $3 | — | $3 | 10.71% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 19 E 200 SOUTH STE 1000 SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2 | — | $2 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CLAIMS ADMINISTRATION | Other services; Named fiduciary; Direct payment from the plan; Contract Administrator; Claims processing; Non-monetary compensation; Float revenue; 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 | 768 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 768 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 498 | $4.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 498 | $4.4M |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 675 | $40K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 768 | $31K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 768 | $55K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 445 | $24K |
| Other(7 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 768 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 768 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.