| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | 160 W SANTA CLARA ST, STE 450 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $25K | — | $25K | 4.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 W. 47TH STREET STE 1100 KANSAS CITY, MO 64112 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $18K | — | $18K | 4.87% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | SAINT MARY'S HEALTHFIRST | $14K | — | $14K | 4.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 5.00% |
| NFP INSURANCE SERVICES INC3 | 109 LAURENS ROAD STE 1A GREENVILLE, SC 29607 | SUN LIFE ASSURANCE COMPANY OF CANADA | $467 | — | $467 | 0.50% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | HEALTH CARE SERVICE CORPORATION | $1K | $207 | $1K | 3.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 11440 TOMAHAWK CREEK PARKWAY LEAWOOD, KS 66211 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $336 | — | $336 | 2.99% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $806 | — | $806 | 10.00% |
| JOHNSON RESOURCES3 Filed as: JOHNSON RESOURCES - AZ | 7373 E DOUBLETREE RANCH #200 SCOTTSDALE, AZ 85258 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $161 | — | $161 | 2.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $445 | — | $445 | 9.99% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $79 | — | $79 | 9.99% |
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 | 173 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 72 | $1.4M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 137 | $93K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 117 | $8K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 173 | $24K |
| Long-term disability(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 173 | $28K |
| Prescription drug | SAINT MARY'S HEALTHFIRST | 52 | $349K |
| Other(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 173 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.