| 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 45263 | AETNA LIFE INSURANCE CO. | $443 | — | $443 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD AND ASSOCIATES | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | AETNA LIFE INSURANCE CO. | $180 | — | $180 | 0.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV | 951 YAMATO RD. SUITE 200W BOCA RATON, FL 33431 | GUARDIAN | $16K | — | $16K | 6.07% |
| ESSENTIAL FINANCIAL ASSOCIATES3 | 7950 EAST ACOMA DRIVE SUITE 110 SCOTTSDALE, AZ 85260 | GUARDIAN | $4K | — | $4K | 1.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOC INC. | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | GUARDIAN | $2K | — | $2K | 0.74% |
| ANDREA MORTENSON4 | UNIT 273 16211 N. SCOTTSDALE RD. SCOTTSDALE, AZ 85254 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $10K | — | $10K | 43.62% |
| WCH CONSULTANTS LLC4 | SUITE 300-180 20118 N 67TH AVE GLENDALE, AZ 85308 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $83 | — | $83 | 0.37% |
| EAGLE ENTERPRISES LLC4 Filed as: EAGLE SUCCESS TEAM LLC | SUITE J PMB 321 5901 WYOMING BLVD NE ALBUQUERQUE, NM 87109 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $20 | — | $20 | 0.09% |
| HEALTH AND BENEFIT SYSTEMS, INC.4 Filed as: HEALTH & BENEFIT SYSTEMS INC | SUITE 500 6363 COLLEGE BLVD OVERLAND PARK, KS 66211 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $18 | — | $18 | 0.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SVCS INC EIN 31-1582098 BROKER | Other commissions Service code 55 | — | $90K |
| BLACK GOULD AND ASSOCIATES BROKER | Other commissions Service code 55 | 3800 N CENTRAL AVE. 9TH FLOOR PHOENIX, AZ 85012 | $38K |
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 | 777 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 777 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 777 | $2.8M |
| Dental | GUARDIAN | 599 | $259K |
| Vision | GUARDIAN | 599 | $259K |
| Life insurance | AETNA LIFE INSURANCE CO. | 777 | $2.8M |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 777 | $2.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 777 | — |
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.