| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W 47TH ST SUITE 1100 KANSAS CITY, ME 64112 | AMERITAS LIFE INSURANCE CORP | $3K | $2K | $5K | 4.10% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $3K | $13K | 25.77% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $3K | $12K | 26.03% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 15.96% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $4K | 15.93% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $965 | — | $965 | 4.41% |
| KIMBERLY RODRIGUEZ3 | 37057 S GAMBEL QUAIL DR MARANA, AZ 85658 | AFLAC | $1K | $78 | $1K | 5.58% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $497 | — | $497 | 2.52% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $462 | $15 | $477 | 2.42% |
| RACHEL DAY3 | 5533 E 24TH STREET TUCSON, AZ 85711 | AFLAC | $279 | — | $279 | 1.42% |
| ZAKERY HARLOW3 | 3204 N ACADEMY BLVD SUITE 130 COLORADO SPRINGS, CO 80917 | AFLAC | $156 | $16 | $172 | 0.87% |
| CATHERINE DAVIS3 | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $149 | — | $149 | 0.76% |
| SCOTT WEBB3 | 12366 W MILTON DR PEORIA, AZ 85383 | AFLAC | $113 | $16 | $129 | 0.65% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $46 | — | $46 | 0.23% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N ORACLE RD 178 PMB 152 TUCSON, AZ 85704 | AFLAC | $43 | — | $43 | 0.22% |
| JENNIFER GOOCH3 | 4897 W HURSTON DR TUCSON, AZ 85742 | AFLAC | $42 | — | $42 | 0.21% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $28 | — | $28 | 0.14% |
| JOSEPH GARCIA3 | 2101 N SANDARIO RD TUCSON, AZ 85743 | AFLAC | $22 | — | $22 | 0.11% |
| BETH LAKE3 | 863 W PINE ST TUCSON, AL 85704 | AFLAC | $20 | — | $20 | 0.10% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $18 | — | $18 | 0.09% |
| LESLIE J BAILEY3 Filed as: LESLIE BAILEY | 4234 N PORTAGE AVE MERIDIAN, ID 83646 | AFLAC | $11 | — | $11 | 0.06% |
| PATRICIA ALMADA3 | 5685 E BEVERLY STREET TUCSON, AL 85711 | AFLAC | $9 | — | $9 | 0.05% |
| DIANA VIDISKY3 | 3365 NORTH VIEW CREST DR TUCSON, AZ 85745 | AFLAC | $7 | — | $7 | 0.04% |
| JILL RAE RODRIGUEZ3 Filed as: JILL RODRIGUEZ | 2782 W CARNATION PL TUCSON, AZ 85745 | AFLAC | $4 | — | $4 | 0.02% |
| SEAN BEYER3 | 7508 W SHINING AMBER LN TUCSON, AZ 85743 | AFLAC | $2 | — | $2 | 0.01% |
| JACOB SUPAK3 | 2311 RANCH CLUB RD PMB 142 SILVER CITY, NM 88061 | AFLAC | $2 | — | $2 | 0.01% |
| PREFERRED MARKETING CORP3 | 1194 E LAKEVIEW DR SAN TAN VALLEY, AZ 85143 | AFLAC | $1 | — | $1 | 0.01% |
| KIMBERLY RODRIGUEZ3 | 37057 S GAMBEL QUAIL DR MARANA, AZ 85658 | AFLAC | $1K | $126 | $1K | 8.22% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $620 | $25 | $645 | 3.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $610 | — | $610 | 3.41% |
| ZAKERY HARLOW3 | 3204 N ACADEMY BLVD SUITE 130 COLORADO SPRINGS, CO 80917 | AFLAC | $249 | $25 | $274 | 1.53% |
| RACHEL DAY3 | 5533 E 24TH STREET TUCSON, AZ 85711 | AFLAC | $222 | — | $222 | 1.24% |
| SCOTT WEBB3 | 12366 W MILTON DR PEORIA, AZ 85383 | AFLAC | $194 | $25 | $219 | 1.22% |
| JENNIFER GOOCH3 | 4897 W HURSTON DR TUCSON, AZ 85742 | AFLAC | $89 | — | $89 | 0.50% |
| MARK HILL3 | 7673 N SUMMIT PASS PRESCOTT VALLEY, AZ 86315 | AFLAC | $87 | — | $87 | 0.49% |
| H OLIPHANT3 | 3580 WEST INA ROAD SUITE 150 TUCSON, AZ 85741 | AFLAC | $63 | — | $63 | 0.35% |
| LESLIE J BAILEY3 Filed as: LESLIE BAILEY | 4234 N PORTAGE AVENUE MERIDIAN, ID 83646 | AFLAC | $26 | — | $26 | 0.15% |
| CATHERINE DAVIS3 | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $20 | — | $20 | 0.11% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $14 | — | $14 | 0.08% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N ORACLE RD 178 PMB 152 TUCSON, AZ 85704 | AFLAC | $12 | — | $12 | 0.07% |
| PATRICIA ALMADA3 | 5685 E BEVERLY STREET TUCSON, AZ 85711 | AFLAC | $9 | — | $9 | 0.05% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $7 | — | $7 | 0.04% |
| SEAN BEYER3 | 7508 W SHINING AMBER LN TUCSON, AZ 85743 | AFLAC | $2 | — | $2 | 0.01% |
| KIMBERLY RODRIGUEZ3 | 37057 S GAMBEL QUAIL DR MARANA, AZ 85658 | AFLAC | $732 | $40 | $772 | 8.09% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $348 | — | $348 | 3.65% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $333 | $8 | $341 | 3.57% |
| RACHEL DAY3 | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $182 | — | $182 | 1.91% |
| ZAKERY HARLOW3 | 2304 N ACADEMY BLVD SUITE 130 COLORADO SPRINGS, CO 80917 | AFLAC | $153 | $8 | $161 | 1.69% |
| SCOTT WEBB3 | 12366 W MILTON DR PEORIA, AZ 85383 | AFLAC | $96 | $8 | $104 | 1.09% |
| CAROL E MONTGOMERY3 | 104 S 3RD AVE TUCSON, AZ 85701 | AFLAC | $44 | — | $44 | 0.46% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $37 | — | $37 | 0.39% |
| LAUREL L HARLOW3 Filed as: LAUREL HARLOW | 6200 W ROAN PL TUCSON, AL 85743 | AFLAC | $16 | — | $16 | 0.17% |
| JENNIFER GOOCH3 | 4897 W HURSTON DR TUCSON, AL 85742 | AFLAC | $15 | — | $15 | 0.16% |
| ANCO INS. SVC. OF BRYAN COLLEGE STA3 Filed as: ANCO SERVICES CORPORATION | 1101 KING ST SUITE 380 ALEXANDRIA, VA 22314 | AFLAC | $15 | — | $15 | 0.16% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N ORACLE RD 179 PMB 152 TUCSON, AZ 85704 | AFLAC | $14 | — | $14 | 0.15% |
| NANCY L SIGL3 Filed as: NANCY SIGL | 21 YARROW LN NOVATO, CA 94947 | AFLAC | $13 | — | $13 | 0.14% |
| SEFCU ASSET MGMT SERV/TBA SEFCU INS3 Filed as: SEFCU ASSET MANAGEMENT SERVICES LLC | 469 STATE ST SCHENECTADY, NY 12305 | AFLAC | $13 | — | $13 | 0.14% |
| LESLIE J BAILEY3 Filed as: LESLIE BAILEY | 4234 N PORTAGE AVE MERIDIAN, ID 83646 | AFLAC | $12 | — | $12 | 0.13% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $12 | — | $12 | 0.13% |
| BARRY GLASS3 | 46 ABERFIELD LANE MIAMISBURG, OH 45342 | AFLAC | $10 | — | $10 | 0.10% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $10 | — | $10 | 0.10% |
| CHAD P SCHNEIDER3 Filed as: CHAD SCHNEIDER | 360 W HUBBARD ST APT 1105 CHICAGO, IL 60654 | AFLAC | $9 | — | $9 | 0.09% |
| ANNE STRONG3 | 1482 E TASCAL LOOP TUCSON, AZ 85737 | AFLAC | $4 | — | $4 | 0.04% |
| JAMES HARVEY3 | 1091 W CALLE EXCELSO GREEN VALLEY, AZ 85614 | AFLAC | $3 | — | $3 | 0.03% |
| SEAN BEYER3 | 7508 W SHINING AMBER LN TUCSON, AZ 85743 | AFLAC | $2 | — | $2 | 0.02% |
| JOSEPH GARCIA3 | 2101 N SANDARIO RD TUCSON, AZ 85743 | AFLAC | $1 | — | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $88K |
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 | 255 | 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) | 255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP | 255 | $129K |
| Vision | VISION SERVICE PLAN | 72 | $22K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $73K |
| Short-term disability(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 73 | $93K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $31K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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.