| 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 | AMERITAS LIFE INSURANCE CORP. | $3K | $2K | $6K | 4.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV INC. | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $12K | 24.43% |
| TREVOR BRYAN DAVIS3 | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $4K | $223 | $4K | 8.44% |
| NICHOLAS J DONIA3 | 843 W CALLE MURO FUERTE SAHUARITA, AZ 85629 | AFLAC | $1K | $40 | $1K | 2.81% |
| CATHERINE DAVIS3 | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $1K | $4 | $1K | 2.72% |
| KELLY MCGARRY3 | 4742 N ORACLE RD STE 210 TUCSON, AZ 85705 | AFLAC | $844 | $40 | $884 | 1.93% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | 11396 N SILVER PHEASANT LOOP ORO VALLEY, AZ 85737 | AFLAC | $275 | — | $275 | 0.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $209 | — | $209 | 0.46% |
| MICHAEL FATHERREE3 | 171 COUNTRY RD. 1559 ALBA, TX 85658 | AFLAC | $103 | — | $103 | 0.22% |
| ZAKERY ALLEN HARLOW3 | 2030 BASELINE RD STE 182-17062 PHOENIX, AZ 85041 | AFLAC | $75 | — | $75 | 0.16% |
| AUSTIN JOHN HOFFMAN3 | 14566 S CAMINO VENDAVAL SAHUARITA, AZ 85629 | AFLAC | $71 | — | $71 | 0.15% |
| BRENDAN M BILLSON3 | 12080 E 8TH STREET TUCSON, AZ 85748 | AFLAC | $61 | — | $61 | 0.13% |
| MARK METTILLE3 Filed as: MARK WHEELER | 5344 E ACOMA DR SCOTTSDALE, AZ 85254 | AFLAC | $44 | — | $44 | 0.10% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $35 | — | $35 | 0.08% |
| SANDRA L SARFF3 | 3811 E CHICO LN TUCSON, AZ 85739 | AFLAC | $35 | — | $35 | 0.08% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 6605 N 93RD AVE GLENDALE, AZ 85305 | AFLAC | $31 | — | $31 | 0.07% |
| JACOB C ECHOLS3 | 15824 E PARK AVE GILBERT, AZ 85234 | AFLAC | $28 | — | $28 | 0.06% |
| JACOB CARTER3 | 9454 E BURNETT ST TUCSON, AZ 85730 | AFLAC | $27 | — | $27 | 0.06% |
| RACHEL DAY3 | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $24 | — | $24 | 0.05% |
| SANDBROOK BENEFITS GROUP LLC3 | 7320 N LA CHOLLA BLVD STE 154-219 TUCSON, AZ 85741 | AFLAC | $22 | — | $22 | 0.05% |
| KIMBERLY RODRIGUEZ3 | 1201 N 45TH DR SHOW LOW, AZ 85901 | AFLAC | $20 | — | $20 | 0.04% |
| SCOTT WEBB3 | 26729 N 91ST DR. PEORIA, AZ 85383 | AFLAC | $16 | — | $16 | 0.03% |
| MARK HILL3 | 5188 E PARK VISTA DR TUCSON, AZ 85756 | AFLAC | $16 | — | $16 | 0.03% |
| ERIC JOHNSON3 | 3850 E BASELINE RD STE 121 MESA, AZ 85206 | AFLAC | $14 | — | $14 | 0.03% |
| JONATHAN ANDREW FERGUSON3 | 5960 FAIRVIEW RD STE 400 CHARLOTTE, NC 28210 | AFLAC | $12 | — | $12 | 0.03% |
| DANA OLIVIA KELDERMAN3 | 13397 N FLAXLEAF PL TUCSON, AZ 85755 | AFLAC | $10 | — | $10 | 0.02% |
| JOHN PATTON3 | 730 BLACK OAK DR CORONA, CA 92881 | AFLAC | $9 | — | $9 | 0.02% |
| DONALD GREEN3 | 4719 S HARVEST MOON DR GREEN VALLEY, AZ 85622 | AFLAC | $8 | — | $8 | 0.02% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $7 | — | $7 | 0.02% |
| ESPENSCHIED BUSINESS GROUP LLC3 | 7669 E MILTON DR SCOTTSDALE, AZ 85266 | AFLAC | $7 | — | $7 | 0.02% |
| CHAD P SCHNEIDER3 | 22213 1/2 ERWIN ST WOODLAND HILLS, CA 91367 | AFLAC | $5 | — | $5 | 0.01% |
| SHARON MCKELVEY3 | 589 E CONESTOGA DR GRAND JUNCTION, CO 81504 | AFLAC | $4 | — | $4 | 0.01% |
| JEFFREY S GIBSON3 Filed as: JEFFREY GIBSON | 4030 TATES CREEK RD APT 1004 CONSHOHOCKEN, PA 40517 | AFLAC | $3 | — | $3 | 0.01% |
| SHAWN HOLTORF3 | 5522 W NORTHWOOD DR. GLENDALE, AZ 85310 | AFLAC | $3 | — | $3 | 0.01% |
| MICHAEL G GLADNICK3 Filed as: MICHAEL GLADNICK | 3850 E BASELINE RD SUITE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.00% |
| NATALIE MALHAM3 | 5822 N 13TH ST PHOENIX, AZ 85014 | AFLAC | $2 | — | $2 | 0.00% |
| JEFFREY A KLEINMAN SR3 | 515 E CAREFREE HWY PMB 323 PHOENIX, AZ 85085 | AFLAC | $2 | — | $2 | 0.00% |
| BARBARA ANN MCNAUGHTON3 | 4910 CORPORATE DR NW SUITE G HUNTSVILLE, AL 35805 | AFLAC | $2 | — | $2 | 0.00% |
| LAUREL L HARLOW3 | 2030 W BASELINE RD STE 182 PHOENIX, AZ 85041 | AFLAC | $1 | — | $1 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV. INC | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 14.21% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $453 | — | $453 | 1.42% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV. INC | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $1K | $7K | 24.90% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $148K |
| JORGENSEN HEALTHCARE ASSOCIATES INC EIN 86-0687859 EAP PROVIDER | Other services Service code 49 | — | $19K |
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 | 266 | 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) | 266 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 484 | $141K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 484 | $173K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 266 | $59K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $93K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 218 | $35K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 266 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 484 | — |
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.