| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $17K | — | $17K | 8.25% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $110 | $110 | 0.05% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 15.00% |
| NFP INSURANCE SERVICES INC3 | 109 LAURENS RD SUITE 1A GREENVILLE, SC 29607 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $113 | $113 | 0.60% |
| DEBORAH NELSON3 Filed as: DEBORAH C YOUNG | 318 N CARSON STREET 104 CARSON CITY, NV 45263 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 24.12% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 20.72% |
| AMY M EDMONDS3 | PO BOX 6597 FOLSOM, CA 95763 | CONTINENTAL AMERICAN INSURANCE COMPANY | $984 | — | $984 | 5.54% |
| ROBERT PILKENTON3 | 3351 DUCKHORN DR 428 SACRAMENTO, CA 95834 | CONTINENTAL AMERICAN INSURANCE COMPANY | $152 | — | $152 | 0.86% |
| LISA M HUTCHERSON3 | 193 BLUE RAVINE ROAD SUITE 140 FOLSOM, CA 95630 | CONTINENTAL AMERICAN INSURANCE COMPANY | $148 | — | $148 | 0.83% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W 47TH ST STE 1100 KANSAS CITY, MO 641121922 | AMERITAS LIFE INSURANCE CORP | $6K | $194 | $6K | 35.77% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 11440 TOMAHAWK CREEK PARKWAY LEAWOOD, KS 66211 | UNITED HEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 12.83% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS GROUP | 5006 LYNDALE AVENUE SOUTH MINNEAPOLIS, MN 55419 | UNITED HEALTHCARE INSURANCE COMPANY | $1K | $120 | $1K | 9.84% |
| CALIFORNIA BENEFIT PLANS INC3 | ONE EAST CAMELBACK ROAD SUITE 840 PHOENIX, AZ 85012 | UNITED HEALTHCARE INSURANCE COMPANY | $904 | — | $904 | 6.38% |
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 | 216 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP | 216 | $17K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 141 | $14K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 175 | $206K |
| Long-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 64 | $36K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 175 | $206K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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.