| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 W. 47TH ST., SUITE 1100 KANSAS CITY, MO 64112 | AMERITAS LIFE INSURANCE CORP. | $3K | $2K | $5K | 4.15% |
| CATHERINE DAVIS3 | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $4K | $389 | $4K | 10.31% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $851 | — | $851 | 2.18% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $829 | $22 | $851 | 2.18% |
| ZAKERY HARLOW3 | 2960 N ACADEMY BLVD STE 101 COLORADO SPRINGS, CO 80917 | AFLAC | $251 | $61 | $312 | 0.80% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 3029 N SONORAN HILLS MESA, AZ 85207 | AFLAC | $311 | — | $311 | 0.80% |
| KIMBERLY RODRIGUEZ3 | 37057 S. GAMBEL QUAIL DR. MARANA, AZ 85658 | AFLAC | $236 | $22 | $258 | 0.66% |
| TREVOR BRYAN DAVIS3 Filed as: TREVOR DAVIS | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $197 | $17 | $214 | 0.55% |
| MICHAEL FATHERREE3 | 171 COUNTY ROAD 1559 ALBA, TX 75410 | AFLAC | $175 | — | $175 | 0.45% |
| DANA OLIVIA KELDERMAN3 Filed as: DANA KELDERMAN | 13397 N FLAXLEAF PL TUCSON, AZ 85755 | AFLAC | $103 | $33 | $136 | 0.35% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N. ORACLE RD. PMB 152 TUCSON, AZ 85704 | AFLAC | $80 | — | $80 | 0.21% |
| JOHN PATTON3 | 13497 EAGLE NEST CT CORONA, CA 92880 | AFLAC | $74 | — | $74 | 0.19% |
| MARK METTILLE3 Filed as: MARK WHEELER | 5344 E ACOMA DR SCOTTSDALE, AZ 85254 | AFLAC | $62 | — | $62 | 0.16% |
| RACHEL DAY3 | 5533 E 254TH ST TUCSON, AZ 85711 | AFLAC | $45 | — | $45 | 0.12% |
| CHAD P SCHNEIDER3 Filed as: CHAD SCHNEIDER | 360 W HUBBARD ST APT 1105 CHICAGO, IL 60654 | AFLAC | $42 | — | $42 | 0.11% |
| JACOB C ECHOLS3 Filed as: JACOB ECHOLS | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $41 | — | $41 | 0.11% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $35 | — | $35 | 0.09% |
| SCOTT WEBB3 | 12366 W MILTON DR. PEORIA, AZ 85383 | AFLAC | $33 | — | $33 | 0.08% |
| JACOB CARTER3 | 8916 E ALDERPOINT WAY TUCSON, AZ 85730 | AFLAC | $30 | — | $30 | 0.08% |
| ERIC JOHNSON3 | 3850 E BASELINE RD STE 121 MESA, AZ 85206 | AFLAC | $20 | — | $20 | 0.05% |
| J A FERGUSON AND ASSOC INC3 Filed as: JA FERGUSON & ASSOC INC | 959 HERRONS FERRY RD ROCK HILL, SC 29730 | AFLAC | $18 | — | $18 | 0.05% |
| FRANK NORTHRUP3 | 3501 N FREEWAY 65 TUCSON, AZ 85705 | AFLAC | $17 | — | $17 | 0.04% |
| PATRICIA ALMADA3 Filed as: PATRICIA ALMDA | 5685 E BEVERLY ST TUCSON, AZ 85711 | AFLAC | $15 | — | $15 | 0.04% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $15 | — | $15 | 0.04% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $13 | — | $13 | 0.03% |
| ESPENSCHIED BUSINESS GROUP LLC3 | 7669 E MILTON DR SCOTTSDALE, AZ 85266 | AFLAC | $9 | — | $9 | 0.02% |
| SUSAN MULLIGAN3 | 818 S MANN AVE TUCSON, AZ 85710 | AFLAC | $9 | — | $9 | 0.02% |
| MICHAEL L BRAUN3 Filed as: MICHAEL BRAUN | 1718 DEVOE DR LINCOLN, NE 68506 | AFLAC | $8 | — | $8 | 0.02% |
| SHARON MCKELVEY3 | 197 N NOTTINGHAM LN LOT 3 PAYSON, AZ 85541 | AFLAC | $7 | — | $7 | 0.02% |
| SHAWN HOLTORF3 | 5522 W NORTHWOOD DR GLENDALE, AZ 85310 | AFLAC | $6 | — | $6 | 0.02% |
| JEFFERY S GIBSON3 Filed as: JEFFERY GIBSON | 3009 HUNTON COTTAGE LN GLEN ALLEN, VA 23059 | AFLAC | $5 | — | $5 | 0.01% |
| APRIL L FARRELL3 Filed as: APRIL FARRELL | 4809 W. TULSA ST. CHANDLER, AZ 85226 | AFLAC | $5 | — | $5 | 0.01% |
| JEFFREY A KLEINMAN SR3 Filed as: JEFFREY KLEINMAN SR. | 3420 E SHEA BLVD STE 168 PHOENIX, AZ 85028 | AFLAC | $4 | — | $4 | 0.01% |
| NATALIE MALHAM3 | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $4 | — | $4 | 0.01% |
| MICAHEL G. GLADNICK3 | 3850 E. BASELINE RD. SUITE 116 MESA, AZ 85206 | AFLAC | $4 | — | $4 | 0.01% |
| BARBARA ANN MCNAUGHTON3 Filed as: BARBARA MCNAUGHTON | 4910 CORPORATE DR. NW STE G HUNTSVILLE, AL 35805 | AFLAC | $3 | — | $3 | 0.01% |
| JOHN A DONALDSON3 Filed as: JOHN DONALDSON | 25211 GROGANS MILL RD STE 305 THE WOODLANDS, TX 77380 | AFLAC | $2 | — | $2 | 0.01% |
| LAUREL L HARLOW3 Filed as: LAUREL HARLOW | 6200 W. ROAN PLACE TUCSON, AZ 85743 | AFLAC | $2 | — | $2 | 0.01% |
| RAYMOND MULLIGAN3 | 8765 W KELTON LN BLDG 81 PEORIA, AZ 77382 | AFLAC | $1 | — | $1 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV INC. | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 26.19% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | 700 W. 4TH ST SUITE 1100 KANSAS CITY, MO 64112 | VISION SERVICE PLAN | $653 | — | $653 | 2.43% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV. INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 26.41% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $4K | 16.08% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV. INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 16.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $98K |
| JORGENSEN HEALTHCARE ASSOCIATES INC EIN 86-0687859 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $13K |
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 | 254 | 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) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 473 | $127K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 473 | $154K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 254 | $51K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 95 | $68K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 157 | $24K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 254 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 473 | — |
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.