| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $1K | — | $1K | 5.05% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $584 | $2K | 13.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERIBEN/IEC GROUP EIN 82-0497661 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | 2303 N. 44TH ST. SUITE 14-1467 PHOENIX, AZ 85008 | $81K |
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 THIRD PARTY ADMINISTRATOR | Other insurance fees and expenses Service code 73 | 2444 W. LAS PALMARITAS DR. PHOENIX, AZ 85021 | $49K |
| CBIZ BENEFITS INSURANCE EIN 06-0838648 BROKER | Other commissions Service code 55 | 11440 TOMAHAWK CREEK PKWY LEAWOOD, KS 66211 | $6K |
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 | 263 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 177 | $25K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 253 | $15K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 263 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 263 | — |
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.