| 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 452632886 | AETNA LIFE INSURANCE CO. | $527 | — | $527 | 0.09% |
| HELEN HAGARDT3 | 9067 N IRONWOOD MEADOWS DRIVE TUCSON, AZ 85742 | AFLAC | $5K | $27 | $5K | 11.46% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 160 W SANTA CLARA ST SUITE 450 SAN JOSE, CA 95113 | AFLAC | $1K | — | $1K | 3.09% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $1K | — | $1K | 2.91% |
| SETH G KNOWLTON3 | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $821 | — | $821 | 2.02% |
| JOHN PATTON3 | 13497 EAGLE NEST CT CORONA, CA 92880 | AFLAC | $341 | $5 | $346 | 0.85% |
| ZAKERY ALLEN HARLOW3 | 3204 N ACADEMY BLVD SUITE 130 COLORADO SPRINGS, CO 80917 | AFLAC | $238 | $5 | $243 | 0.60% |
| SANDRA L SARFF3 | 7090 N ORACLE RD 178 PMB 152 TUCSON, AZ 85704 | AFLAC | $178 | — | $178 | 0.44% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $156 | — | $156 | 0.38% |
| MICHAEL FATHERREE3 | 171 COUNTY ROAD 1559 ALBA, TX 75410 | AFLAC | $132 | — | $132 | 0.32% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $102 | — | $102 | 0.25% |
| CHAD P SCHNEIDER3 | 360 W HUBBARD ST APT 1105 CHICAGO, IL 60654 | AFLAC | $96 | — | $96 | 0.24% |
| CATHERINE DAVIS3 Filed as: CATHERINE B DAVIS | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $75 | — | $75 | 0.18% |
| SARA BRIERY3 Filed as: SARA E BRIERY | 4 MARBURG LN SAVANNAH, GA 31411 | AFLAC | $75 | — | $75 | 0.18% |
| DONALD GREEN3 Filed as: DONALD A GREEN | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $46 | — | $46 | 0.11% |
| SANDRA L SARFF3 | 7090 N ORACLE RD PMB 152 TUCSON, AZ 85704 | AFLAC | $41 | — | $41 | 0.10% |
| BENJAMIN J HAGARDT3 | 9076 N IRONWOOD MEADOWS DR TUCSON, AZ 85742 | AFLAC | $20 | — | $20 | 0.05% |
| CHEYANNA SARFF3 | 3737 W CROMWELL DR TUCSON, AZ 85741 | AFLAC | $17 | — | $17 | 0.04% |
| JEANNETTE E FATHERREE3 | 171 COUNTY ROAD 1559 ALBA, TX 75410 | AFLAC | $16 | — | $16 | 0.04% |
| NANCY L SIGL3 | 21 YARROW LN NOVATO, CA 94947 | AFLAC | $15 | — | $15 | 0.04% |
| SCOTT WEBB3 | 2155 W PINNACLE PEAK RD SUITE 205 PHOENIX, AZ 85027 | AFLAC | $15 | — | $15 | 0.04% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $13 | — | $13 | 0.03% |
| SHARIN I MCKELVEY3 | 197 N NOTTINHAM LN LOT 3 PAYSON, AZ 85541 | AFLAC | $5 | — | $5 | 0.01% |
| JOHN BURLEY3 Filed as: JOHN DOUGLAS BURLEY | 3060 W CALLE LUCINDA TUCSON, AZ 85741 | AFLAC | $4 | — | $4 | 0.01% |
| LAUREL L HARLOW3 | 6200 W ROAN PL TUCSON, AZ 85743 | AFLAC | $4 | — | $4 | 0.01% |
| SCOTT WEBB3 | 12366 W MILTON DR PEORIA, AZ 85383 | AFLAC | $4 | — | $4 | 0.01% |
| MICHAEL G GLADNICK3 | 3850 E BASELINE RD SUITE 116 MESA, AZ 85206 | AFLAC | $3 | — | $3 | 0.01% |
| NATALIE MALHAM3 | 3850 E BASELINE RD SUITE 116 MESA, AZ 85206 | AFLAC | $3 | — | $3 | 0.01% |
| JEFFREY A KLEINMAN SR3 | 3420 E SHEA BLVD SUITE 166 PHOENIX, AZ 85028 | AFLAC | $3 | — | $3 | 0.01% |
| JEFFERY S GIBSON3 | 4805 LAKE BROOK DRIVE SUITE 220 GLEN ALLEN, VA 23060 | AFLAC | $2 | — | $2 | 0.00% |
| JULIA ANN COAST3 | 1409 E MALIBU DR TEMPE, AZ 85282 | AFLAC | $1 | — | $1 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | PRINCIPAL LIFE INSURANCE COMPANY | $967 | — | $967 | 8.71% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $615 | — | $615 | 5.93% |
No Schedule C service providers reported on this filing.
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 | 130 | 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) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 130 | $566K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 80 | $21K |
| Vision | AETNA LIFE INSURANCE CO. | 130 | $566K |
| Short-term disability | AFLAC | 71 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.