| 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 45263 | AMERITAS LIFE INSURANCE CORP. | $3K | $2K | $4K | 4.41% |
| CATHERINE DAVIS3 | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $4K | $332 | $4K | 10.72% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $1K | — | $1K | 3.55% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $1K | $82 | $1K | 3.04% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 3029 N SONORAN HILLS MESA, AZ 85207 | AFLAC | $471 | $62 | $533 | 1.37% |
| ZAKERY HARLOW3 | 2960 N ACADEMY BLVD STE 101 COLORADO SPRINGS, CO 80917 | AFLAC | $188 | — | $188 | 0.48% |
| KELLY MCGARRY3 | 4750 N ORACLE RD STE 214 TUCSON, AZ 85705 | AFLAC | $172 | — | $172 | 0.44% |
| TREVOR BRYAN DAVIS3 Filed as: TREVOR DAVIS | 9160 E LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $114 | $24 | $138 | 0.35% |
| MICHAEL FATHERREE3 | 171 COUNTRY RD. 1559 ALBA, TX 85658 | AFLAC | $136 | — | $136 | 0.35% |
| KIMBERLY RODRIGUEZ3 | 37057 S GAMBEL QUAIL DR MARANA, AZ 85658 | AFLAC | $108 | — | $108 | 0.28% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N. ORACLE RD. PMB 152 TUCSON, AZ 85704 | AFLAC | $62 | — | $62 | 0.16% |
| MARK METTILLE3 Filed as: MARK WHEELER | 5344 E ACOMA DR SCOTTSDALE, AZ 85254 | AFLAC | $47 | — | $47 | 0.12% |
| RACHEL DAY3 | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $45 | — | $45 | 0.12% |
| DANA OLIVIA KELDERMAN3 Filed as: DANA KELDERMAN | 13397 N FLAXLEAF PL TUCSON, AZ 85755 | AFLAC | $33 | — | $33 | 0.08% |
| JACOB C ECHOLS3 Filed as: JACOB CECHOLS | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $30 | — | $30 | 0.08% |
| JACOB CARTER3 | 8916 E ALDERPOINT WAY TUCSON, AZ 85730 | AFLAC | $27 | — | $27 | 0.07% |
| SCOTT WEBB3 | 26729 N 91ST DR. PEORIA, AZ 85383 | AFLAC | $26 | — | $26 | 0.07% |
| CHAD P SCHNEIDER3 Filed as: CHAD SCHNEIDER | 1 W SUPERIOR ST APT 1301 CHICAGO, IL 60654 | AFLAC | $16 | — | $16 | 0.04% |
| ERIC JOHNSON3 | 3850 E BASELINE RD STE 121 MESA, AZ 85206 | AFLAC | $15 | — | $15 | 0.04% |
| MARK HILL3 | 5188 E PARK VISTA DR. TUCSON, AZ 85756 | AFLAC | $14 | — | $14 | 0.04% |
| J A FERGUSON AND ASSOC INC3 Filed as: JA FERGUSON & ASSOC INC | 959 HERRONS FERRY RD ROCK HILL, SC 29730 | AFLAC | $13 | — | $13 | 0.03% |
| JOHN PATTON3 | 13497 EAGLE NEST CT. CORONA, CA 92880 | AFLAC | $13 | — | $13 | 0.03% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $13 | — | $13 | 0.03% |
| PATRICIA ALMADA3 | 5685 E BEVERLY ST TUCSON, AZ 85711 | AFLAC | $13 | — | $13 | 0.03% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $8 | — | $8 | 0.02% |
| ESPENSCHIED BUSINESS GROUP LLC3 | 7669 E MILTON DR SCOTTSDALE, AZ 85266 | AFLAC | $7 | — | $7 | 0.02% |
| SHARON MCKELVEY3 | 197 N NOTTINGHAM LOT 3 PAYSON, AZ 85541 | AFLAC | $6 | — | $6 | 0.02% |
| SHAWN HOLTORF3 | 5522 W NORTHWOOD DR. GLENDALE, AZ 85310 | AFLAC | $6 | — | $6 | 0.02% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $5 | — | $5 | 0.01% |
| JEFFREY S GIBSON3 Filed as: JEFFREY GIBSON | 3009 HUNTON COTTAGE LANE GLEN ALLEN, VA 23059 | AFLAC | $4 | — | $4 | 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% |
| BARBARA ANN MCNAUGHTON3 Filed as: BARBARA MCNAUGHTON | 4910 CORPORATE DR. NW SUITE G HUNTSVILLE, AL 35805 | AFLAC | $3 | — | $3 | 0.01% |
| MICHAEL G GLADNICK3 Filed as: MICHAEL GLADNICK | 3850 E BASELINE RD SUITE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.01% |
| NATALIE MALHAM3 | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.01% |
| LAUREL L HARLOW3 Filed as: LAUREL HARLOW | 6200 W ROAN PL TUCSON, AZ 85743 | 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 | $1K | $7K | 24.21% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | 700 W. 4TH ST SUITE 1100 KANSAS CITY, MO 64112 | VISION SERVICE PLAN | $566 | — | $566 | 2.20% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV. INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 24.85% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 14.61% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV. INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 14.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $79K |
| JORGENSEN HEALTHCARE ASSOCIATES INC EIN 86-0687859 EAP PROVIDER | Other services Service code 49 | — | $21K |
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 | 256 | 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) | 256 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 431 | $94K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 431 | $119K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $48K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 97 | $69K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 190 | $23K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 431 | — |
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.