| 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. | $518 | — | $518 | 0.09% |
| HELEN HAGARDT3 | 9067 N IRONWOOD MEADOWS DRIVE TUCSON, AZ 85742 | AFLAC | $6K | $123 | $6K | 13.98% |
| SETH G KNOWLTON3 | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $2K | $38 | $2K | 3.62% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 3029 N. SONORAN HILLS MESA, AZ 85207 | AFLAC | $796 | — | $796 | 1.79% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $726 | — | $726 | 1.63% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 160 W SANRTA CLARA ST STE 450 SAN JOSE, CA 95113 | AFLAC | $292 | — | $292 | 0.66% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $244 | $11 | $255 | 0.57% |
| JOHN PATTON3 | 13497 EAGLE NEST CT CORONA, CA 92880 | AFLAC | $200 | — | $200 | 0.45% |
| ZAKERY ALLEN HARLOW3 | 2960 N ACADEMY BLVD. SUITE 101 COLORADO SPRINGS, CO 80917 | AFLAC | $185 | — | $185 | 0.42% |
| SANDRA L SARFF3 | 7090 N ORACLE RD PMB 152 TUCSON, AZ 85704 | AFLAC | $180 | — | $180 | 0.40% |
| RACHEL DAY3 | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $147 | — | $147 | 0.33% |
| CHAD P SCHNEIDER3 Filed as: CHAD SCHNEIDER | 1 W SUPERIOR ST APT 1301 CHICAGO, IL 60654 | AFLAC | $91 | — | $91 | 0.20% |
| MICHAEL FATHERREE3 | 171 COUNTRY ROAD 1559 ALBA, TX 75410 | AFLAC | $78 | — | $78 | 0.18% |
| CATHERINE DAVIS3 | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $78 | — | $78 | 0.18% |
| SARA BRIERY3 | 4 MARBURG LANE SAVANNAH, GA 31411 | AFLAC | $78 | — | $78 | 0.18% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $41 | — | $41 | 0.09% |
| MARK HILL3 | 5188 E PARK VISTA DR. TUCSON, AZ 85756 | AFLAC | $35 | — | $35 | 0.08% |
| CHEYANNA SARFF3 | 3737 W. CROMWELL DR. TUCSON, AZ 85741 | AFLAC | $21 | — | $21 | 0.05% |
| JEANNETTE FATHERREE3 | 171 COUNTRY ROAD 1559 ALBA, TX 75410 | AFLAC | $19 | — | $19 | 0.04% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $16 | — | $16 | 0.04% |
| SCOTT WEBB3 | 26729 N. 91ST. DR PEORIA, AZ 85042 | AFLAC | $16 | — | $16 | 0.04% |
| JOHN BURLEY3 Filed as: JOHN DOUGLAS BURLEY | 3989 W ORANGEWOOD DR. TUCSON, AZ 85741 | AFLAC | $5 | — | $5 | 0.01% |
| SHARON MCKELVEY3 | 197 N NOTTINGHAM LANE LOT 3 PAYSON, AZ 85541 | AFLAC | $4 | — | $4 | 0.01% |
| JEFFREY A KLEINMAN SR3 | 3420 E SHEA BLVD SUITE 166 PHOENIX, AZ 85028 | AFLAC | $3 | — | $3 | 0.01% |
| BENJAMIN J HAGARDT3 Filed as: BENJAMIN HAGARDT | 9076 N IRONWOOD MEADOWS DR. TUCSON, AZ 85742 | AFLAC | $3 | — | $3 | 0.01% |
| NATALIE MALHAM3 | 3850 E BASELINE RD SUITE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.00% |
| LAUREL L HARLOW3 Filed as: LAUREL HARLOW | 6200 W ROAN PL TUCSON, AZ 85743 | AFLAC | $2 | — | $2 | 0.00% |
| MICHAEL G GLADNICK3 Filed as: MICHAEL GLADNICK | 3850 E BASELINE ST STE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.00% |
| JEFFERY S GIBSON3 Filed as: JEFFERY GIBSON | 4805 LAKE BROOK DR. STE 220 GLEN ALLEN, VA 23060 | 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 | $1K | $119 | $1K | 9.58% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $674 | — | $674 | 5.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CBIZ BENEFITS & INS SERVICES INC. EIN 31-1582098 BROKER | Insurance agents and brokers Service code 22 | PO BOX 632886 CINCINNATI, OH 45263 | $30K |
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 | 136 | 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) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 136 | $595K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 92 | $24K |
| Vision | AETNA LIFE INSURANCE CO. | 136 | $595K |
| Short-term disability | AFLAC | 66 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 136 | — |
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.