| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | PROMINENCE HEALTH PLAN | $18K | — | $18K | 3.52% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 WEST 47TH STREET SUITE 1100 KANSAS CITY, MO 64112 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $22K | — | $22K | 5.32% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 160 WEST SANTA CLARA STREET SUITE 450 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $12K | — | $12K | 4.36% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | HEALTH CARE SERVICE CORPORATION | $595 | $27 | $622 | 2.07% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 5.07% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $261 | — | $261 | 3.17% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $714 | — | $714 | 9.76% |
| JOHNSON RESOURCES3 Filed as: JOHNSON RESOURCES - AZ | 7373 E DOUBLETREE RANCH #200 SCOTTSDALE, AZ 85258 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $143 | — | $143 | 1.96% |
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 | 204 | 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) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | PROMINENCE HEALTH PLAN | 91 | $1.2M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 142 | $24K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 146 | $7K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 213 | $26K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 213 | $26K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 213 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 213 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.