| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W 47TH STREET SUITE 1100 KANSAS CITY, MO 641121922 | AMERITAS LIFE INSURANCE CORP. | $3K | $3K | $5K | 4.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $3K | $17K | 24.66% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 14.91% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $2K | $13K | 24.51% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $3K | — | $3K | 8.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 14.92% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | ASSOCIATED VISION CARE PLAN | $2K | — | $2K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W 47TH STREET SUITE 1100 KANSAS CITY, MO 641121922 | AMERITAS LIFE INSURANCE CORP. | $233 | $3K | $3K | 27.83% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | 700 W 47TH STREET SUITE 1100 KANSAS CITY, MO 641121922 | EMPLOYERS DENTAL SERVICES | $353 | — | $353 | 7.78% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $450 | $208 | $658 | 14.63% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $620 | $154 | $774 | 24.97% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $301 | $145 | $446 | 14.83% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $445 | $110 | $555 | 24.92% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W 47TH STREET SUITE 1100 KANSAS CITY, MO 641121922 | ASSOCIATED VISION CARE PLAN LLC | $122 | — | $122 | 9.97% |
| JORGENSEN HEALTHCARE ASSOCIATES3 | 2292 WEST MAGEE ROAD, SUITE 290 TUCSON, AL 85742 | JORGENSEN HEALTHCARE ASSOCIATES DBA JORGENSEN BROOKS GROUP | $0 | $5K | $5K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $368K |
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 | 540 | 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) | 540 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(4 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 418 | $195K |
| Vision(4 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 418 | $165K |
| Life insurance(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 540 | $117K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 174 | $53K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 540 | $63K |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 590 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 590 | — |
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.