| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RACHEL DAY3 | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $3K | — | $3K | 7.30% |
| GAIL PARSON3 | 750 W ORANGE GROVE RD APT 24101 TUCSON, AZ 85704 | AFLAC | $3K | — | $3K | 6.40% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $2K | $51 | $2K | 4.18% |
| HELEN HAGARDT3 | 9076 N IRONWOOD MEADOWS DR TUCSON, AZ 85742 | AFLAC | $1K | $253 | $1K | 2.75% |
| KELLY MCGARRY3 | 4750 N ORACLE RD. SUITE 214 TUCSON, AZ 85705 | AFLAC | $1K | — | $1K | 2.31% |
| DAVID R LATTIMER3 Filed as: DAVID LATTIMER | 3029 N SORORAN HILLS MESA, AZ 85207 | AFLAC | $108 | $51 | $159 | 0.35% |
| MARK HILL3 | 5188 E PARK VISTA DR. TUCSON, AZ 85756 | AFLAC | $149 | — | $149 | 0.33% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N ORACLE RD PMB 152 TUCSON, AZ 85704 | AFLAC | $149 | — | $149 | 0.33% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $143 | — | $143 | 0.31% |
| ZAKERY ALLEN HARLOW3 | 2960 N ACADEMY BLVD. SUITE 101 COLORADO SPRINGS, CO 80917 | AFLAC | $119 | — | $119 | 0.26% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $79 | — | $79 | 0.17% |
| CATHERINE DAVIS3 | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $72 | — | $72 | 0.16% |
| SARA BRIERY3 | 4 MARBURG LANE SAVANNAH, GA 31411 | AFLAC | $72 | — | $72 | 0.16% |
| CHAD P SCHNEIDER3 Filed as: CHAD SCHNEIDER | 4470 WOODMAN AVE UNIT 303 SHERMAN OAKS, CA 91423 | AFLAC | $67 | — | $67 | 0.15% |
| JOHN PATTON3 | 13497 EAGLE NEST CT CORONA, CA 92880 | AFLAC | $52 | — | $52 | 0.11% |
| MICHAEL FATHERREE3 | 171 COUNTY ROAD 1559 ALBA, TX 75410 | AFLAC | $51 | — | $51 | 0.11% |
| JAISTINA HANSEN3 | PO BOX 2131 PINETOP, AZ 85935 | AFLAC | $14 | $26 | $40 | 0.09% |
| DONALD GREEN3 | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $37 | — | $37 | 0.08% |
| SAM RICHMOND3 | 1765 LAKE HAVASU AVE N LAKE HAVASU CITY, AZ 86404 | AFLAC | $15 | $9 | $24 | 0.05% |
| CHEYANNA SARFF3 | 3737 W CROMWELL DR. TUCSON, AZ 85741 | AFLAC | $19 | — | $19 | 0.04% |
| JEANETTE FATHERREE3 | 171 COUNTY RD. 1559 ALBA, TX 75410 | AFLAC | $17 | — | $17 | 0.04% |
| ERIC PEDERSON3 | 2532 N 4TH ST PMB 556 FLAGSTAFF, AZ 86004 | AFLAC | $7 | $9 | $16 | 0.04% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $15 | — | $15 | 0.03% |
| CHAD P SCHNEIDER3 Filed as: CHAD SCHNEIDER | 1 W SUPERIOR ST APT 1301 CHICAGO, IL 60654 | AFLAC | $14 | — | $14 | 0.03% |
| SCOTT WEBB3 | 26729 N 91ST DR PEORIA, AZ 85383 | AFLAC | $13 | — | $13 | 0.03% |
| JOHN BURLEY3 | 3989 W ORANGEWOOD DR TUCSON, AZ 85741 | AFLAC | $4 | — | $4 | 0.01% |
| SHARON MCKELVEY3 | 197 N NOTTINGHAM LN LOT 3 PAYSON, AZ 85541 | AFLAC | $4 | — | $4 | 0.01% |
| JEFFERY KLEINMAN SR3 | 33202 N 46TH WAY CAVE CREEK, AZ 85331 | AFLAC | $2 | — | $2 | 0.00% |
| LAUREL L HARLOW3 Filed as: LAUREL HARLOW | 6200 W ROAN PL TUCSON, AZ 85743 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL G GLADNICK3 Filed as: MICHAEL GLADNICK | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $1 | — | $1 | 0.00% |
| NATALIE MALHAM3 | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | 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 | $136 | $1K | 9.17% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $656 | — | $656 | 5.94% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | AETNA LIFE INSURANCE CO. | $541 | — | $541 | 20.79% |
| 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 | $33K |
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 121 | $624K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 81 | $25K |
| Vision | AETNA LIFE INSURANCE CO. | 70 | $3K |
| Short-term disability | AFLAC | 52 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 121 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.