| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | UNITED HEALTHCARE INSURANCE COMPANY | $4K | $27K | $31K | 1.99% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 7.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 15800 CRABBS BRANCH WAY #350 ROCKVILLE, MD 20855 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | -$250 | — | -$250 | -0.23% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $5K | — | $5K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 702 KING FARM BLVD, STE 210 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $3K | — | $3K | 5.72% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $4K | — | $4K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 702 KING FARM BLVD, STE 210 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $2K | — | $2K | 5.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $2K | — | $2K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 702 KING FARM BLVD, STE 210 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $1K | — | $1K | 5.62% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | — | $2K | 13.10% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 25.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 702 KING FARM BLVD, STE 210 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $720 | $720 | 12.48% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $533 | — | $533 | 10.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 702 KING FARM BLVD, STE 210 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | $304 | — | $304 | 5.71% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 29.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 702 KING FARM BLVD, STE 210 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $586 | $586 | 15.50% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $607 | — | $607 | 29.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 702 KING FARM BLVD, STE 210 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $323 | $323 | 15.69% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $140 | — | $140 | 24.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 702 KING FARM BLVD, STE 120 ROCKVILLE, MD 20850 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $65 | $65 | 11.59% |
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 | 155 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 222 | $1.7M |
| Dental(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 222 | $1.7M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 318 | $12K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | 155 | $59K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | 155 | $22K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | 155 | $40K |
| Prescription drug(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 222 | $1.7M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA - NYL | 155 | $6K |
| 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.