| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAROL JEAN HALL3 | PO BOX 15158 TUCSON, AZ 85708 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $137 | $2K | 5.70% |
| R AND T FIGUEROA LLC3 Filed as: R & T FIGUEROA | 7569 S CARLISLE AVE TUCSON, AZ 85746 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $84 | $1K | 3.76% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $781 | $16 | $797 | 2.32% |
| CAROL VAN3 | 3120 WINDJAMMER DR COLORADO SPRINGS, CO 80920 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $573 | — | $573 | 1.67% |
| EC BENEFIT INC3 | 8038 S 38TH PLACE PHOENIX, AZ 85042 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $443 | — | $443 | 1.29% |
| PAUL A BYNUM3 | PO BOX 12306 TUCSON, AZ 85732 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $298 | — | $298 | 0.87% |
| VINCENT TAYLOR ECHOLS3 | PO BOX 594 THATCHER, AZ 85552 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $197 | $29 | $226 | 0.66% |
| JOSEPH QUINTANA3 | 27 N COUNTRY CLUB DRIVE PHOENIX, AZ 85014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $71 | — | $71 | 0.21% |
| BST COMPANIES INC3 Filed as: BST COMPANIES | 48 E DOWNTOWN STREET TUCSON, AZ 85701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.07% |
| REYNALDO R GRAJEDA3 | 4915 CAMINO DE MONTE NE ALBUQUERQUE, NM 87111 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $1K | — | $1K | 4.94% |
| JULIE KICKER3 Filed as: JULIE A KICKER | 719 E COTTONWOOD LN CASA GRANDE, AZ 85139 | AFLAC | $401 | $9 | $410 | 3.14% |
| JACKIE G BARTA3 | 3500 N MALLARD CIR SIERRA VISTA, AZ 85635 | AFLAC | $357 | $35 | $392 | 3.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $363 | — | $363 | 2.78% |
| SANDRA L SARFF3 | 7090 N ORACLE ROAD 178 PMB 152 TUCSON, AZ 85704 | AFLAC | $188 | — | $188 | 1.44% |
| JOHN DOLLAR3 Filed as: JOHN R DOLLAR | 588 E WOLF HOLLOW DRIVE CASA GRANDE, AZ 85122 | AFLAC | $182 | — | $182 | 1.39% |
| KEVIN DALE HARLOW3 | 6281 N ORACLE RD UNIT 35072 TUCSON, AZ 85740 | AFLAC | $111 | $7 | $118 | 0.90% |
| NANCY L SIGL3 | 21 YARROW LANE NOVATO, CA 94947 | AFLAC | $117 | — | $117 | 0.90% |
| ZAKERY ALLEN HARLOW3 | 4568 N 1ST AVE SUITE 140 TUCSON, AZ 85718 | AFLAC | $78 | $9 | $87 | 0.67% |
| SCOTT WEBB3 | 2355 W PINNACLE PEAK ROAD SUITE 380 PHOENIX, AZ 85027 | AFLAC | $58 | $9 | $67 | 0.51% |
| CATHERINE DAVIS3 Filed as: CATHERINE B DAVIS | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $60 | — | $60 | 0.46% |
| JACK GATHINGS3 | 7235 S GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $50 | — | $50 | 0.38% |
| MARK K HASLEY3 | 21925 N 70TH AVE GLENDALE, AZ 85310 | AFLAC | $15 | — | $15 | 0.11% |
| LAUREL L HARLOW3 | 4566 N 1ST AVE STE 140 TUCSON, AZ 85718 | AFLAC | $7 | $2 | $9 | 0.07% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $3 | — | $3 | 0.02% |
| ANELLE SUMMERS3 | 7109 E PORT AU PRINCE PLACE TUCSON, AZ 85710 | AFLAC | $1 | — | $1 | 0.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | EMPLOYERS DENTAL SERVICES | $111 | — | $111 | 7.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $175K |
| CBIZ BENEFITS AND INS SERVICES INC EIN 31-1582098 BROKER | Other commissions Service code 55 | — | $54K |
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $19K |
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 | 188 | 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) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | EMPLOYERS DENTAL SERVICES | 10 | $2K |
| Vision | VISION SERVICE PLAN | 188 | $26K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 42 | $47K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 448 | $243K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 448 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.