| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | DENISE S SMITH 175 S WEST TEMPLE STE 650 SALT LAKE CITY, UT 84101 | REGENCE BLUECROSS BLUESHIELD OF UTAH | $23K | $2K | $26K | 1.90% |
| BENEFITS PLANNING CORP.3 Filed as: BENEFITS PLANNING SERVICES INC | MICHELLE MASTERS 700 W 47TH ST STE 1100 ROCKFORD, IL 61108 | REGENCE BLUECROSS BLUESHIELD OF UTAH | $17K | $0 | $17K | 1.27% |
| BENEFIT PLANNING SERVICES INC3 | 6833 STALTER DR ROCKFORD, IL 61108 | DELTA DENTAL INSURANCE COMPANY | $5K | $0 | $5K | 4.67% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632866 CINCINNATI, OH 45263 | DELTA DENTAL INSURANCE COMPANY | $2K | $0 | $2K | 2.33% |
| BENEFIT PLANNING SERVICES INC3 | 6833 STALTER DR ROCKFORD, IL 61108 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $634 | $0 | $634 | 2.33% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $124 | $423 | $547 | 2.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $515 | $366 | $881 | 4.07% |
| BENEFIT PLANNING SERVICES INC3 | 6833 STALTER DR ROCKFORD, IL 61108 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $501 | $0 | $501 | 2.32% |
| BENEFIT PLANNING SERVICES INC3 | 6833 STALTER DR ROCKFORD, IL 61108 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $391 | $0 | $391 | 2.33% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $76 | $267 | $343 | 2.04% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | LIFEMAP ASSURANCE COMPANY | $265 | $0 | $265 | 2.50% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES (UT) INC | 3900 NO. TRAVERSE MTN BLVD #301 LEHI, UT 84043 | LIFEMAP ASSURANCE COMPANY | $262 | $0 | $262 | 2.47% |
| CUSTOM INSURANCE SPECIALISTS INC3 | 886 E 3200 N KAMAS, UT 84036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $555 | $52 | $607 | 9.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 19 EAST 200 SOUTH SALT LAKE CITY, UT 84111 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $373 | $0 | $373 | 5.90% |
| JILL HUGHES3 | 6510 TAMARA DRIVE SALT LAKE CITY, UT 84129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | $4 | $36 | 0.57% |
| PAM ANDERSON & ASSOCIATES INC3 | 5818 S 900 E MURRAY, UT 84121 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.09% |
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 | 180 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 289 | $1.4M |
| Dental | DELTA DENTAL INSURANCE COMPANY | 318 | $97K |
| Vision | LIFEMAP ASSURANCE COMPANY | 89 | $11K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $22K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $27K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $17K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 318 | — |
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.