| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | 160 W. SANTA CLARA STREET SUITE 450 SAN JOSE, CA 951131762 | KAISER FOUNDATION HEALTH PLAN INC | $110K | — | $110K | 4.25% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 10474 SANTA MONICA BLVD, STE 200 LOS ANGELES, CA 90025 | CALIFORNIA PHYSICIANS' SERVICE | $55K | $73 | $55K | 3.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED CONCORDIA INSURANCE COMPANY | $33K | — | $33K | 10.03% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $2K | — | $2K | 3.09% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 13.36% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 13.47% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $6K | 13.46% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED CONCORDIA DENTAL PLAN OF CALIFORNIA, INC. | $5K | — | $5K | 10.05% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $505 | $184 | $689 | 13.65% |
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 | 582 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 588 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 560 | $4.4M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 622 | $377K |
| Vision | VISION SERVICE PLAN | 516 | $69K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 592 | $112K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 72 | $5K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 597 | $48K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 381 | $1.8M |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 597 | $161K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 622 | — |
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.