| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC INC | 160 W SANTA CLARA ST STE 450 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $77K | — | $77K | 5.72% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC INC | 700 W 47TH ST STE 1100 KANSAS CITY, MO 64112 | UNITEDHEALTHCARE INSURANCE COMPANY | $26K | — | $26K | 5.43% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC (OH) | P.O. BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $15K | — | $15K | 9.94% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC INC | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | — | $7K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC INC | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC INC | P.O. BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $962 | — | $962 | 6.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC INC | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $936 | — | $936 | 15.00% |
| LANETTA MARSHALL3 | 126 VERNON ST SAN FRANCISCO, CA 94132 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $581 | — | $581 | 12.83% |
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS SEE ATTACHED AFLAC SCHEDULE | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $279 | $53 | $332 | 13.86% |
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 | 104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 172 | $1.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 100 | $146K |
| Vision | VISION SERVICE PLAN | 103 | $16K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 104 | $45K |
| Short-term disability | AFLAC | 2 | $2K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 104 | $20K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 172 | $1.4M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 104 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 172 | — |
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.