| 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 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 15.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: LOVITT & TOUCHE, A MARSH MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | — | $7K | 11.61% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $6K | — | $6K | 9.91% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | PO BOX 350 CONSHOCKEN, PA 19428 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $976 | $976 | 1.57% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 9.17% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: LOVITT & TOUCHE, A MARSH MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 4.06% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: LOVITT & TOUCHE, A MARSH MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 5.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA DENTAL HEALTH PLAN OF ARIZONA, INC. | $2K | — | $2K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 11.90% |
| JOHNSON RESOURCES3 | 10801 E HAPPY VALLEY ROAD UNIT 78 SCOTTSDALE, AZ 85255 | FIDELITY SECURITY LIFE INSURANCE COMPANY | — | $277 | $277 | 1.98% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $506 | — | $506 | 9.56% |
| PAYCOM PAYROLL LLC3 | 7501 W MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $169 | $169 | 3.19% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $501 | — | $501 | 9.53% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL BLVD OKLAHOMA CITY, OK 73142 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $167 | $167 | 3.18% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $452 | — | $452 | 9.43% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $151 | $151 | 3.15% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $353 | — | $353 | 9.99% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: LOVITT & TOUCHE, A MARSH MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $276 | — | $276 | 7.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $51K |
| CURALINC, LLC, DBA CURALINC HEALTH EIN 33-1206383 CLAIMS PROCESSING | Direct payment from the plan; Participant communication; Contract Administrator; Claims processing Service code 12 | 314 WEST SUPERIOR STREET, SUITE 601 CHICAGO, IL 60654 | $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 | 584 | 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) | 584 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 310 | $82K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 459 | $14K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 566 | $25K |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 584 | $73K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 340 | $30K |
| Other(4 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 584 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 584 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.