| 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 | $20K | — | $20K | 15.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: THE NIA GROUP, MARSH & MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.83% |
| 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 | $7K | — | $7K | 9.91% |
| 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 | 5.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: THE NIA GROUP, MARSH & MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 1.84% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 10.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: THE NIA GROUP, MARSH & MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $964 | $964 | 1.83% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 12.15% |
| 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 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 16.12% |
| 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 | -1.27% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 16.13% |
| PAYCOM PAYROLL LLC3 | 7501 W MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | -$169 | -$169 | -1.33% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 16.52% |
| 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 | -1.48% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $723 | — | $723 | 10.01% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: THE NIA GROUP, MARSH & MCLELLAN | 161 WASHINGTON STREET STE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $104 | $104 | 1.44% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | CIGNA DENTAL HEALTH OF KANSAS, INC. | $8 | — | $8 | 9.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $180K |
| CURALINC, LLC, DBA CURALINC HEALTH EIN 33-1206383 CLAIMS PROCESSING | Direct payment from the plan; Participant communication; Claims processing; Contract Administrator Service code 12 | 314 WEST SUPERIOR STREET, SUITE 601 CHICAGO, IL 60654 | $13K |
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 | 429 | 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) | 429 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 291 | $85K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 387 | $28K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 380 | $53K |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 380 | $154K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 355 | $61K |
| Other(4 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 188 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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.