| 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 | $5K | 4.48% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERV INC. | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $10K | 24.13% |
| CATHERINE DAVIS3 | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $5K | $109 | $5K | 11.86% |
| NICHOLAS J DONIA3 | 843 W CALLE MURO FUERTE SAHUARITA, AZ 85629 | AFLAC | $942 | $11 | $953 | 2.43% |
| KELLY MCGARRY3 | 4750 N ORACLE RD STE 214 TUCSON, AZ 85705 | AFLAC | $772 | $25 | $797 | 2.03% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $545 | — | $545 | 1.39% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | 11396 N SILVER PHEASANT LOOP ORO VALLEY, AZ 85737 | AFLAC | $390 | — | $390 | 0.99% |
| TREVOR BRYAN DAVIS3 | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $132 | — | $132 | 0.34% |
| MICHAEL FATHERREE3 | 171 COUNTRY RD. 1559 ALBA, TX 85658 | AFLAC | $95 | — | $95 | 0.24% |
| ZAKERY ALLEN HARLOW3 | 2030 BASELINE RD STE 182-17062 PHOENIX, AZ 85041 | AFLAC | $75 | — | $75 | 0.19% |
| KIMBERLY RODRIGUEZ3 | 37057 S GAMBEL QUAIL DR MARANA, AZ 85658 | AFLAC | $60 | — | $60 | 0.15% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $44 | $15 | $59 | 0.15% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 6605 N 93RD AVE GLENDALE, AZ 85305 | AFLAC | $53 | — | $53 | 0.14% |
| RACHEL DAY3 | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $41 | — | $41 | 0.10% |
| MARK METTILLE3 Filed as: MARK WHEELER | 5344 E ACOMA DR SCOTTSDALE, AZ 85254 | AFLAC | $40 | — | $40 | 0.10% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS. SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $39 | — | $39 | 0.10% |
| SANDBROOK BENEFITS GROUP LLC3 | 7320 N LA CHOLLA BLVD STE 154-219 TUCSON, AZ 85741 | AFLAC | $32 | — | $32 | 0.08% |
| SANDRA L SARFF3 | 3811 E CHICO LN TUCSON, AZ 85739 | AFLAC | $32 | — | $32 | 0.08% |
| JACOB C ECHOLS3 | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $26 | — | $26 | 0.07% |
| JACOB CARTER3 | 9454 E BURNETT ST TUCSON, AZ 85730 | AFLAC | $26 | — | $26 | 0.07% |
| SCOTT WEBB3 | 26729 N 91ST DR. PEORIA, AZ 85383 | AFLAC | $20 | — | $20 | 0.05% |
| DANA OLIVIA KELDERMAN3 | 13397 N FLAXLEAF PL TUCSON, AZ 85755 | AFLAC | $19 | — | $19 | 0.05% |
| MARK HILL3 | 5188 E PARK VISTA DR TUCSON, AZ 85756 | AFLAC | $15 | — | $15 | 0.04% |
| ERIC JOHNSON3 | 3850 E BASELINE RD STE 121 MESA, AZ 85206 | AFLAC | $13 | — | $13 | 0.03% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $12 | — | $12 | 0.03% |
| PATRICIA ALMADA3 | 5685 E BEVERLY ST TUCSON, AZ 85711 | AFLAC | $11 | — | $11 | 0.03% |
| J A FERGUSON AND ASSOC INC3 Filed as: J A FERGUSON & ASSOC INC | 5549 FIVE KNOLLS DR CHARLOTTE, NC 28226 | AFLAC | $9 | — | $9 | 0.02% |
| JOHN PATTON3 | 730 BLACK OAK DR CORONA, CA 92881 | AFLAC | $8 | — | $8 | 0.02% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $7 | — | $7 | 0.02% |
| ESPENSCHIED BUSINESS GROUP LLC3 | 7669 E MILTON DR SCOTTSDALE, AZ 85266 | AFLAC | $6 | — | $6 | 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 | $3 | — | $3 | 0.01% |
| JEFFREY S GIBSON3 Filed as: JEFFREY GIBSON | 4030 TATES CREEK RD APT 1004 CONSHOHOCKEN, PA 40517 | AFLAC | $2 | — | $2 | 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% |
| CREST INSURANCE GROUP LLC3 | 5285 E WILLIAMS CIR STE 4500 TUCSON, AZ 85711 | AFLAC | $2 | — | $2 | 0.01% |
| BARBARA ANN MCNAUGHTON3 | 4910 CORPORATE DR NW SUITE G HUNTSVILLE, AL 35805 | AFLAC | $1 | — | $1 | 0.00% |
| JONATHAN ANDREW FERGUSON3 | 5960 FAIRVIEW RD STE 400 CHARLOTTE, NC 28210 | 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 | $6K | $1K | $8K | 23.89% |
| 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 | 14.17% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC. | 700 W. 4TH ST SUITE 1100 KANSAS CITY, MO 64112 | VISION SERVICE PLAN | $682 | — | $682 | 2.43% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $120K |
| 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 | 273 | 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) | 273 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 486 | $111K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 486 | $139K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 273 | $59K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $82K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 201 | $31K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 273 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 486 | — |
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.