| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 0.32% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 20.37% |
| CBIZ BENEFITS & INSURANCE SERVICES4 Filed as: CBIZ BENEFITS AND INSURANCE | 12 CADILLAC DR., STE 160 BRENTWOOD, TN 37027 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $818 | — | $818 | 12.00% |
| CATHERINE L LEE4 Filed as: CATHERINE ALLISON LOMBARD | 5339 E. CALLE VISTA DE COL TUCSON, AZ 85711 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $409 | — | $409 | 6.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC. | 700 W. 47TH STREET KANSAS CITY, MO 64112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $526 | — | $526 | 10.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $223 | — | $223 | 10.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $240 | — | $240 | 15.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $41 | — | $41 | 9.98% |
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 | 114 | 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) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 247 | $1.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 247 | $1.2M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 176 | $16K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 122 | $18K |
| Short-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 96 | $30K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 96 | $16K |
| Other(4 contracts, 2 carriers) | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | 237 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 247 | — |
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.