| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAYELA FORD3 | 11273 W ROCK ART DR MARANA, AZ 85658 | AFLAC | $8K | $396 | $8K | 9.73% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $6K | — | $6K | 7.67% |
| KELLY MCGARRY3 | 4750 N ORACLE RD STE 214 TUCSON, AZ 85705 | AFLAC | $3K | $7 | $3K | 3.54% |
| SHANNON N GARCIA3 | 2184 N SADDLEWOOD RANCH DR TUCSON, AZ 85745 | AFLAC | $3K | $177 | $3K | 3.32% |
| CARLOS CHAVEZ3 Filed as: CARLOS E CHAVEZ | 4750 N ORACLE RD STE 214 TUCSON, AZ 85705 | AFLAC | $1K | $73 | $1K | 1.55% |
| SETH G KNOWLTON3 | 11396 N SILVER PHEASANT LOOP ORO VALLEY, AZ 85737 | AFLAC | $345 | — | $345 | 0.42% |
| RACHEL DAY3 Filed as: RACHEL S DAY | 5533 E 24TH ST TUCSON, AZ 85711 | AFLAC | $317 | — | $317 | 0.38% |
| HELEN HAGARDT3 | 9076 N IRONWOOD MEADOWS DR TUCSON, AZ 85742 | AFLAC | $314 | — | $314 | 0.38% |
| ASIAH ANTONIO FUENTES3 | 1319 E EDISON ST TUCSON, AZ 85719 | AFLAC | $249 | $2 | $251 | 0.30% |
| JACKIE G BARTA3 | 3500 N MALLARD CIR SIERRA VISTA, AZ 85635 | AFLAC | $137 | — | $137 | 0.17% |
| SANDRA L SARFF3 | 3811 E CHICO LN TUCSON, AZ 85739 | AFLAC | $102 | — | $102 | 0.12% |
| ERIK PAUL ISHOY3 | 100 GOLF LINKS RD APT 601 SIERRA VISTA, AZ 85635 | AFLAC | $92 | — | $92 | 0.11% |
| MARK HILL3 | 5188 E PARK VISTA DR TUCSON, AZ 85756 | AFLAC | $61 | — | $61 | 0.07% |
| CHAD P SCHNEIDER3 | 22213 1/2 ERWIN ST WOODLAND HILLS, CA 91367 | AFLAC | $35 | — | $35 | 0.04% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $33 | — | $33 | 0.04% |
| DAVID R LATTIMER3 | 6605 N 93RD AVE GLENDALE, AZ 85305 | AFLAC | $33 | — | $33 | 0.04% |
| JEREMY MICHAEL PETERSON3 | 1319 E EDISON ST TUCSON, AZ 85719 | AFLAC | $30 | — | $30 | 0.04% |
| SARA BRIERY3 Filed as: SARA E BRIERY | 4 MARBURN LN SAVANNAH, GA 31411 | AFLAC | $27 | — | $27 | 0.03% |
| CATHERINE DAVIS3 Filed as: CATHERINE B DAVIS | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $27 | — | $27 | 0.03% |
| CHEYANNA SARFF3 | 3737 W CROMWELL DR TUCSON, AZ 85741 | AFLAC | $21 | — | $21 | 0.03% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LN PHOENIX, AZ 85042 | AFLAC | $16 | — | $16 | 0.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 160 W SANTA CLARA ST STE 675 SAN JOSE, CA 95113 | AFLAC | $15 | — | $15 | 0.02% |
| DONALD GREEN3 Filed as: DONALD A GREEN | 4719 S HARVEST MOON DR GREEN VALLEY, AZ 85622 | AFLAC | $14 | — | $14 | 0.02% |
| SCOTT WEBB3 | 26729 N 91ST DR PEORIA, AZ 85383 | AFLAC | $13 | — | $13 | 0.02% |
| GAIL PARSON3 Filed as: GAIL PATRICK PARSONS | 750 W ORANGE GROVE RD APT 24101 TUCSON, AZ 85704 | AFLAC | $12 | — | $12 | 0.01% |
| MICHAEL FATHERREE3 | 171 COUNTY ROAD 1559 ALBA, TX 75410 | AFLAC | $11 | — | $11 | 0.01% |
| ZAKERY ALLEN HARLOW3 | 2030 W BASELINE RD STE 182-17062 PHOENIX, AZ 85041 | AFLAC | $8 | — | $8 | 0.01% |
| JOHN PATTON3 | 730 BLACK OAK DR CORONA, CA 92881 | AFLAC | $2 | — | $2 | 0.00% |
| JEFFREY A KLEINMAN SR3 | 33202 N 46TH WAY CAVE CREEK, AZ 85331 | AFLAC | $2 | — | $2 | 0.00% |
| M & O AGENCIES INC3 | 1835 S EXTENSION RD MESA, AZ 85210 | AFLAC | $2 | — | $2 | 0.00% |
| JOHN BURLEY3 Filed as: JOHN DOUGLAS BURLEY | 5576 W MONTEREY DR TUCSON, AZ 85742 | AFLAC | $2 | — | $2 | 0.00% |
| SHARON MCKELVEY3 Filed as: SHARON I MCKELVEY | 589 E CONESTOGA CIR GRAND JUNCTION, CO 81504 | AFLAC | $1 | — | $1 | 0.00% |
| LAUREL L HARLOW3 | 2030 W BASELINE RD STE 182 PHOENIX, AZ 85041 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL G GLADNICK3 | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $1 | — | $1 | 0.00% |
| NATALIE MALHAM3 | 5822 N 13TH ST PHOENIX, AZ 85014 | AFLAC | $1 | — | $1 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W 47TH ST STE 1100 KANSAS CITY, MO 641122050 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 7.29% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $497 | — | $497 | 5.92% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | AETNA LIFE INSURANCE CO. | — | $2K | $2K | 31.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | AETNA LIFE INSURANCE CO. | $732 | — | $732 | 9.70% |
| 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 | $31K |
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 | 124 | 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) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BANNER HEALTH AND AETNA HEALTH | 124 | $603K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 71 | $31K |
| Vision | AETNA LIFE INSURANCE CO. | 129 | $8K |
| Short-term disability | AFLAC | 107 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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.