| 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 64112 | BLUE CROSS BLUE SHIELD OF ARIZONA | $44K | $255 | $44K | 3.32% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | DELTA DENTAL OF ARIZONA | $3K | — | $3K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 3101 N CENTRAL AVE SUITE 290 PHOENIX, AZ 85012 | AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS | $1K | — | $1K | 5.37% |
| BENEFIT PARTNERS GROUP LLC3 Filed as: BENEFIT PARTNERS INC | 17905 N 81ST WAY SCOTTSDALE, AZ 85255 | AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS | -$137 | — | -$137 | -0.62% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 9.92% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $811 | — | $811 | 6.93% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 951 YAMATO ROAD SUITE 200W BOCA RATON, FL 33431 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 11.21% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 18 NORTH FRANKLIN BLVD UNIT 1 PLEASANTVILLE, NJ 08232 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $419 | — | $419 | 3.79% |
| JOHN DRISCOLL AND COMPANY, INC.3 Filed as: JOHN DRISCOLL AND COMPANY INC | 5050 NORTH 40TH STREET SUITE 350 PHOENIX, AZ 85018 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8 | — | $8 | 0.07% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | CANYON INSURANCE SERVICES | $457 | — | $457 | 10.00% |
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 | 189 | 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) | 189 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 189 | $1.3M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF ARIZONA | 85 | $73K |
| Vision(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 189 | $1.3M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 316 | $20K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 11 | $11K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 189 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 316 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.