| 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. | $4K | $849 | $4K | 3.62% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV INC. | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $2K | $9K | 23.85% |
| CATHERINE DAVIS3 | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $4K | $130 | $4K | 10.91% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $1K | $30 | $1K | 2.87% |
| KELLY MCGARRY3 | 4750 N ORACLE RD STE 214 TUCSON, AZ 85705 | AFLAC | $637 | $30 | $667 | 1.82% |
| SANDBROOK BENEFITS GROUP LLC3 | 7320 N LA CHOLLA BLVD STE 154-219 TUCSON, AZ 85741 | AFLAC | $390 | — | $390 | 1.07% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $357 | — | $357 | 0.98% |
| NICHOLAS J DONIA3 | 843 W CALLE MURO FUERTE SAHUARITA, AZ 85629 | AFLAC | $185 | — | $185 | 0.51% |
| MICHAEL FATHERREE3 | 171 COUNTRY RD. 1559 ALBA, TX 85658 | AFLAC | $106 | — | $106 | 0.29% |
| ZAKERY ALLEN HARLOW3 | 2030 BASELINE RD STE 182-17062 PHOENIX, AZ 85041 | AFLAC | $89 | — | $89 | 0.24% |
| KIMBERLY RODRIGUEZ3 | 37057 S GAMBEL QUAIL DR MARANA, AZ 85658 | AFLAC | $75 | — | $75 | 0.20% |
| MARK METTILLE3 Filed as: MARK WHEELER | 5344 E ACOMA DR SCOTTSDALE, AZ 85254 | AFLAC | $43 | — | $43 | 0.12% |
| RACHEL DAY3 | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $43 | — | $43 | 0.12% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $40 | — | $40 | 0.11% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 3029 N SONORAN HILLS MESA, AZ 85207 | AFLAC | $36 | — | $36 | 0.10% |
| SANDRA L SARFF3 | 7090 N ORACLE RD PMB 152 TUCSON, AZ 85704 | AFLAC | $34 | — | $34 | 0.09% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 6605 N 93RD AVE GLENDALE, AZ 85305 | AFLAC | $32 | — | $32 | 0.09% |
| JACOB C ECHOLS3 | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $28 | — | $28 | 0.08% |
| JACOB CARTER3 | 7900 S LAUDER ST TUCSON, AZ 85747 | AFLAC | $25 | — | $25 | 0.07% |
| DANA OLIVIA KELDERMAN3 | 13397 N FLAXLEAF PL TUCSON, AZ 85755 | AFLAC | $24 | — | $24 | 0.07% |
| SCOTT WEBB3 | 26729 N 91ST DR. PEORIA, AZ 85383 | AFLAC | $22 | — | $22 | 0.06% |
| TREVOR BRYAN DAVIS3 | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $20 | — | $20 | 0.05% |
| MARK HILL3 | 5188 E PARK VISTA DR TUCSON, AZ 85756 | AFLAC | $16 | — | $16 | 0.04% |
| ERIC JOHNSON3 | 3850 E BASELINE RD STE 121 MESA, AZ 85206 | AFLAC | $14 | — | $14 | 0.04% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $13 | — | $13 | 0.04% |
| JOHN PATTON3 | 13497 EAGLE NEST CT CORONA, CA 92880 | AFLAC | $13 | — | $13 | 0.04% |
| PATRICIA ALMADA3 | 5685 E BEVERLY ST TUCSON, AZ 85711 | AFLAC | $12 | — | $12 | 0.03% |
| J A FERGUSON AND ASSOC INC3 Filed as: J A FERGUSON & ASSOC INC | 959 HERRONS FERRY RD ROCK HILL, SC 29730 | AFLAC | $12 | — | $12 | 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% |
| CHAD P SCHNEIDER3 | 4470 WOODMAN AVE UNIT 303 SHERMAN OAKS, CA 91423 | AFLAC | $6 | — | $6 | 0.02% |
| SHARON MCKELVEY3 | 197 N NOTTINGHAM LOT 3 PAYSON, AZ 85541 | AFLAC | $4 | — | $4 | 0.01% |
| SHAWN HOLTORF3 | 5522 W NORTHWOOD DR. GLENDALE, AZ 85310 | 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% |
| MICHAEL G GLADNICK3 Filed as: MICHAEL GLADNICK | 3850 E BASELINE RD SUITE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.01% |
| NATALIE MALHAM3 | 5822 N 13TH ST PHOENIX, AZ 85014 | AFLAC | $2 | — | $2 | 0.01% |
| JEFFREY A KLEINMAN SR3 | 33202 N 46TH WAY CAVE CREEK, AZ 85331 | AFLAC | $2 | — | $2 | 0.01% |
| JENNIFER O'ROURKE3 Filed as: JENNIFER OROURKE | 9225 TANQUE VERDE RD APT 9103 TUCSON, AZ 85749 | AFLAC | $1 | — | $1 | 0.00% |
| BARBARA ANN MCNAUGHTON3 | 4910 CORPORATE DR NW SUITE G HUNTSVILLE, AL 35805 | AFLAC | $1 | — | $1 | 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 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.11% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | 700 W. 4TH ST SUITE 1100 KANSAS CITY, MO 64112 | VISION SERVICE PLAN | $521 | — | $521 | 1.85% |
| 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 | 24.18% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 14.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $108K |
| JORGENSEN HEALTHCARE ASSOCIATES INC EIN 86-0687859 EAP PROVIDER | Other services Service code 49 | — | $18K |
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 | 274 | 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) | 274 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 497 | $121K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 497 | $149K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 274 | $52K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $76K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 198 | $29K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 274 | $52K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 497 | — |
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.