| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | 700 W. 47TH STREET SUITE 1100 KANSAS CITY, MO 64112 | BLUE CROSS BLUE SHIELD OF ARIZONA | $35K | — | $35K | 29.65% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $2K | $12K | 29.27% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $10K | 30.36% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.38% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $264 | $2K | 7.66% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $944 | $3K | 14.19% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $992 | — | $992 | 5.96% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $904 | — | $904 | 6.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 CLAIMS ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $91K |
| JORGENSEN HEALTHCARE ASSOCIATES INC EIN 86-0687859 EAP PROVIDER | Other services Service code 49 | — | $7K |
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) | BLUE CROSS BLUE SHIELD OF ARIZONA | 121 | $118K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 136 | $43K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 121 | $132K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $57K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $29K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 54 | $41K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 121 | $118K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF ARIZONA | 121 | $118K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $23K |
| 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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.