| 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 | $114 | $3K | 3.65% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 26.24% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 27.06% |
| 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 | $3K | 16.22% |
| KIMBERLY RODRIGUEZ3 | 37057 S GAMBEL QUAIL DR MARANA, AZ 85658 | AFLAC | $1K | $10 | $1K | 7.70% |
| RACHEL DAY3 | 5533 E 24TH STREET TUCSON, AZ 85711 | AFLAC | $463 | $15 | $478 | 2.78% |
| ZAKERY HARLOW3 | 3755 N BUSINESS CENTER DR SUITE 130 TUCSON, AZ 85705 | AFLAC | $323 | $8 | $331 | 1.93% |
| LAUREN L HARLOW3 | 3755 NORTH BUSINESS CENTRE DR TUCSON, AZ 85705 | AFLAC | $214 | — | $214 | 1.25% |
| LAUREL L HARLOW3 | 4566 N 1ST AVE STE 140 TUCSON, AZ 85718 | AFLAC | $212 | — | $212 | 1.23% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $201 | $5 | $206 | 1.20% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $189 | — | $189 | 1.10% |
| SCOTT WEBB3 | 2355 W PINNACLE PEAK RD SUITE 280 PHOENIX, AZ 85027 | AFLAC | $48 | — | $48 | 0.28% |
| JENNIFER GOOCH3 | 4897 W HURSTON DR TUCSON, AZ 85742 | AFLAC | $48 | — | $48 | 0.28% |
| MARK HILL3 | 7673 N SUMMIT PASS PRESCOTT VALLEY, AZ 86315 | AFLAC | $43 | — | $43 | 0.25% |
| CATHERINE DAVIS3 | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $21 | $16 | $37 | 0.22% |
| PATRICIA ALMADA3 Filed as: PATRICIA BOWMAN ALMADA | 5685 E BEVERLY STREET TUCSON, AZ 85711 | AFLAC | $24 | — | $24 | 0.14% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $24 | — | $24 | 0.14% |
| LESLIE J BAILEY3 Filed as: LESLIE BAILEY | 4234 N PORTAGE AVENUE MERIDIAN, ID 83646 | AFLAC | $13 | — | $13 | 0.08% |
| MICHAEL FATHERREE3 | 11876 MOORHEN CIRC FORT WORTH, TX 76244 | AFLAC | $10 | $3 | $13 | 0.08% |
| LOVITT AND TOUCHE, INC.3 Filed as: LOVITT AND TOUCHE INC | PO BOX 32702 TUCSON, AZ 85751 | AFLAC | $9 | — | $9 | 0.05% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $7 | — | $7 | 0.04% |
| ASPEN COVE-DASTRUP INSURANCE INC3 Filed as: ASPEN COVE INSURANCE INC | 4844 N 300 W STE 100 PROVO, UT 84604 | AFLAC | $7 | — | $7 | 0.04% |
| JOSEPH GARCIA3 Filed as: JOSEPH RICHARDO GARCIA | 2101 N SANDARIO RD TUCSON, AZ 85743 | AFLAC | $5 | — | $5 | 0.03% |
| SEAN BEYER3 | 7508 W SHINING AMBER LN TUCSON, AZ 85743 | AFLAC | $1 | — | $1 | 0.01% |
| MICHAEL FATHERREE3 | 171 COUNTY ROAD 1559 ALBA, TX 75410 | AFLAC | $1 | — | $1 | 0.01% |
| CHAD P SCHNEIDER3 | 14430 BENEFIT ST APT 308 SHERMAN OAKS, CA 91423 | AFLAC | $1 | — | $1 | 0.01% |
| SHAWN HOLTORF3 | 6234 WEST DEHREND DR APT 1135 GLENDALE, AZ 85308 | AFLAC | $1 | — | $1 | 0.01% |
| JEFFREY A KLEINMAN SR3 | 3420 E SHEA BLVD STE 168 PHOENIX, AZ 85028 | AFLAC | $1 | — | $1 | 0.01% |
| JEFFERY S GIBSON3 | 14301 N 87TH ST STE 313 SCOTTSDALE, AZ 85260 | AFLAC | $1 | — | $1 | 0.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $812 | $2K | 16.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $833 | — | $833 | 6.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $38K |
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 | 239 | 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) | 239 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP | 239 | $74K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP | 239 | $86K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 97 | $40K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 69 | $44K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 97 | $18K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 97 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 239 | — |
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.