| 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 | $41K | $4 | $41K | 4.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $438 | $3K | 15.96% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 721 EMERSON ROAD, STE 400 ST. LOUIS, MO 63141 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 19.87% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $926 | $150 | $1K | 14.52% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $800 | $81 | $881 | 14.27% |
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 | 114 | 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) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 129 | $1.0M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $17K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 127 | $6K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 111 | $7K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 112 | $20K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 127 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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.