| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $318 | $5K | 7.63% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 15.15% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 15.14% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $6K | 19.83% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $432 | $4K | 17.09% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $762 | $2K | 15.09% |
| R AND T FIGUEROA LLC3 Filed as: R & T FIGUEROA LLC | 7569 S CARLISLE AVE TUCSON, AZ 85746 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $326 | — | $326 | 3.06% |
| EC BENEFITS INC3 | 8038 S 38TH PL PHOENIX, AZ 85042 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $213 | — | $213 | 2.00% |
| CAROL VAN3 | 3120 WINDJAMMER DR COLORADO SPRINGS, CO 80920 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $167 | — | $167 | 1.57% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS INSURANCE SERVICES | 11440 TOMAHAWK CREEK PKWY LEAWOOD, KS 66211 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $57 | — | $57 | 0.53% |
| CAROL JEAN HALL3 | PO BOX 15158 TUCSON, AZ 85708 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.41% |
| PAUL A BYNUM3 | PO BOX 12306 TUCSON, AZ 85732 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.23% |
| JOSEPH QUINTANA3 | 14602 N 7TH PLACE PHOENIX, AZ 85022 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.22% |
| BILL HIGHSMITH3 | 9234 N 32ND PLACE PHOENIX, AZ 85028 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.11% |
| REYNALDO R GRAJEDA3 | 4915 CAMINO DE MONTE NE ALBUQUERQUE, NM 87111 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.06% |
| BST COMPANIES INC3 Filed as: BST COMPANIES | PO BOX 17467 TUCSON, AZ 85731 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $107K |
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 | 352 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 352 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 16 | $11K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 307 | $65K |
| Vision | VISION SERVICE PLAN | 145 | $16K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $43K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 284 | $40K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $42K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 285 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 307 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.