| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SVCS INC. | 11440 TOMAHAWK CREEK PARKWAY ATTN COMMISSION ACCOUNT LEAWOOD, KS 66211 | BLUE SHIELD OF CALIFORNIA | $38K | — | $38K | 5.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SVC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | BLUE SHIELD OF CALIFORNIA | $15K | — | $15K | 2.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | SERVICES, INC. 160 W SANTA CLARA ST STE 450 SAN JOSE, CA 951131762 | KAISER FOUNDATION HEALTH PLAN INC | $21K | — | $21K | 4.99% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | SUN LIFE ASSURANCE COMPANY OF CANADA | $11K | — | $11K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BNFTS & INS SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | SERVICES INC. PO BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $936 | — | $936 | 6.14% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BNFTS & INS SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BNFTS & INS SVCS INC. | PO BOX 632886 CINCINNATI, OH 452632886 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
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 | 153 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 95 | $1.2M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 108 | $105K |
| Vision | VISION SERVICE PLAN | 101 | $15K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 153 | $15K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 153 | $18K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 95 | $757K |
| Other(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 153 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 153 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.