| 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 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $22K | — | $22K | 12.22% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 8.79% |
| NICHOLAS CAFFREY3 | 6502 N CALLE LOTTIE TUCSON, AZ 857181903 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 3.08% |
| SETH G KNOWLTON3 | 11396 N SILVER PHEASANT LOOP ORO VALLEY, AZ 85737 | CONTINENTAL AMERICAN INSURANCE COMPANY | $970 | — | $970 | 2.18% |
| JILL N NEMODE3 | 3173 S HATTUCK SAGINAW, MI 48603 | CONTINENTAL AMERICAN INSURANCE COMPANY | $946 | — | $946 | 2.13% |
| KELLY MCGARRY3 | 8785 N MOONFIRE DR TUCSON, AZ 85743 | CONTINENTAL AMERICAN INSURANCE COMPANY | $668 | — | $668 | 1.50% |
| MATTHEW THOMAS NEMODE3 Filed as: MATTHEW DAVID SOPCZYNSKI | 4146 N PAUL CIR BAY CITY, MI 487066512 | CONTINENTAL AMERICAN INSURANCE COMPANY | $251 | — | $251 | 0.57% |
| MATTHEW THOMAS NEMODE3 Filed as: MATTHEW T NEMODE | 3985 KAWKAWLIN RIVER DR BAY CITY, MI 48706 | CONTINENTAL AMERICAN INSURANCE COMPANY | $162 | — | $162 | 0.36% |
| RACHEL DAY3 Filed as: RACHEL S DAY | 5533 E 24TH ST TUCSON, AZ 85711 | CONTINENTAL AMERICAN INSURANCE COMPANY | $147 | — | $147 | 0.33% |
| KAYELA FORD3 Filed as: KAYELA M FORD | 976 YESTERDAY LANE MEDINA, OH 44256 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | — | $10 | 0.02% |
| KIMBERLY RODRIGUEZ3 Filed as: KIMBERLY JOY GRAHAM RODRIGUEZ | 1201 N 45TH DR SHOW LOW, AZ 89501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | — | $8 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 TPA | Direct payment from the plan; Contract Administrator; Claims processing; Insurance services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Consulting (general) Service code 12 | — | $320K |
| CBIZ BENEFITS & INS SERVICES BROKER | Insurance brokerage commissions and fees; Non-monetary compensation; Insurance agents and brokers; Other commissions; Other fees Service code 22 | PO BOX 632886 CINCINNATI, OH 45263 | $21K |
| PRUDENTIAL INSURANCE COMPANY EIN 22-1211670 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $19K |
| DELTA DENTAL OF ARIZONA EIN 86-0274899 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $16K |
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 | 399 | 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) | 399 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 291 | $60K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 399 | $177K |
| Short-term disability | CONTINENTAL AMERICAN INSURANCE COMPANY | 13 | $44K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 399 | $177K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 399 | $177K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 399 | — |
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.