| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | 951 YAMATO ROAD SUITE 200W BOCA ROATON, FL 33431 | BLUE CROSS BLUE SHIELD HEALTH OPTIONS | $22K | — | $22K | 4.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 951 YAMATO ROAD SUITE 200W BOCA RATON, FL 33431 | BLUE CROSS BLUE SHIELD OF FLORIDA | $18K | — | $18K | 4.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 951 YAMATO ROAD SUITE 200W BOCA RATON, FL 33431 | THE GUARDIAN LIFE INSURANCE COMPANY | $4K | — | $4K | 5.13% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $575 | $2K | 13.62% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $955 | $302 | $1K | 13.16% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $837 | $260 | $1K | 13.10% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITEDHEALTHCARE INSURANCE COMPANY | $971 | — | $971 | 12.73% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ | P O BOX 632886 CINCINNATI, OH 32886 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 100.00% |
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 | 184 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD HEALTH OPTIONS | 79 | $1.0M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY | 143 | $76K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY | 143 | $76K |
| Life insurance(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY | 184 | $100K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 33 | $10K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 15 | $8K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF FLORIDA | 60 | $461K |
| Other(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 184 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.