| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAROL JEAN HALL3 | 5737 E CHAPTER DRIVE TUCSON, AZ 85708 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $69 | $3K | 7.40% |
| R AND T FIGUEROA LLC3 Filed as: R & T FIGUEROA | 7569 S CARLISLE AVE TUCSON, AZ 85746 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $32 | $2K | 3.45% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W 47TH STREET KANSAS CITY, MO 64112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $961 | $11 | $972 | 2.23% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 Filed as: KURZ & VALDEZ BENEFIT ENROLLMENT | 14640 N 90TH DR PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $250 | $327 | $577 | 1.32% |
| CAROL VAN3 | 3120 WINDJAMMER DR. COLORADO SPRINGS, CO 80920 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $329 | — | $329 | 0.75% |
| EC BENEFITS INC3 Filed as: EC BENEFITS INC. | 8038 S 38TH PLACE PHOENIX, AZ 85042 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $152 | — | $152 | 0.35% |
| PAUL BYNUM3 | PO BOX 12306 TUCSON, AZ 85732 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $107 | — | $107 | 0.25% |
| VINCENT TAYLOR ECHOLS3 Filed as: VINCENT ECHOLS | PO BOX 594 THATCHER, AZ 85552 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | — | $58 | 0.13% |
| STEVEN ROBERT KURZ3 | 14640 N 90TH DR PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $22 | $33 | 0.08% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 N BLACK CANYON HWY STE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 0.07% |
| JOSEPH QUINTANA3 | 3022 N 49TH CT PHOENIX, AZ 85018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 0.07% |
| REYNALDO R GRAJEDA3 Filed as: REYNALDO GRAJEDA | 12509 GRAND AVE NE ALBUQUERQUE, NM 87123 | 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 | 4.73% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | EMPLOYERS DENTAL SERVICES | $120 | — | $120 | 7.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $158K |
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $18K |
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 | 194 | 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) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 470 | $424K |
| Dental | EMPLOYERS DENTAL SERVICES | 11 | $2K |
| Vision | VISION SERVICE PLAN | 194 | $29K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 33 | $44K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 470 | $424K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF ARIZONA | 470 | $424K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 470 | — |
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.