| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH STREET STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | $6K | $23K | 20.68% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH STREET STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $19K | $5K | $24K | 25.24% |
| FMLA SOURCE INC5 | 455 N CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $8K | $8K | 8.88% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH STREET STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $10K | 15.50% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $2K | — | $2K | 3.59% |
| R AND T FIGUEROA LLC3 | 7569 S CARLISLE AVE TUCSON, AZ 85746 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $90 | $4K | 7.27% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 3101 N CENTRAL SUITE 300 PHOENIX, AZ 85012 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $27 | $2K | 4.05% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 Filed as: KURZ & VALDEZ BENEFIT ENROLLMENT | 14640 N 90TH DR PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $559 | $675 | $1K | 2.48% |
| BST COMPANIES INC3 | 319 N CAMERON VIEW PLACE TUCSON, AZ 85745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $860 | — | $860 | 1.73% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SVCS | 16220 N SCOTTSDALE RD SCOTTSDALE, AZ 85254 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $492 | — | $492 | 0.99% |
| CAROL JEAN HALL3 | 5737 E CHAPTER DR TUCSON, AZ 85708 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $305 | $9 | $314 | 0.63% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 N BLACK CANYON HWY STE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $106 | — | $106 | 0.21% |
| STEVEN ROBERT KURZ3 | 14640 N 90TH DR PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $30 | $45 | 0.09% |
| EC BENEFITS INC3 | 8308 S 38TH PL PHOENIX, AZ 85042 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | — | $35 | 0.07% |
| MARINA C LOVE3 | 406 HOPKINS ST RIO RICO, AZ 85648 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.04% |
| SHAWN JEFFERY WARREN3 | 6950 WEST ROWEL STREET PEORIA, AZ 85383 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.03% |
| PAUL A BYNUM3 | PO BOX 12306 TUCSON, AZ 85732 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.03% |
| JB & H LLC3 | 8707 E SAGUARO VIEW PL VAIL, AZ 85641 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.03% |
| JOSEPH QUINTANA3 | 3022 N 49TH CT PHOENIX, AZ 85018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.02% |
| ENRIQUE GONZALEZ3 | 1541 N PLACITA COLONIA DE ORO TUCSON, AZ 85745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| DEBORAH ANN BERRY3 | 1042 E 9TH PLACE MESA, AZ 85203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| VINCENT TAYLOR ECHOLS3 | PO BOX 594 THATCHER, AZ 85552 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| JAMES D THRESHER3 | PO BOX 19569 HAPPY JACK, AZ 86024 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH STREET STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 20.23% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $446K |
| INSPIRA FINANCIAL HSA ADMINISTRATOR | Other fees Service code 99 | 2001 SPRING ROAD, SUITE 700 OAK BROOK, IL 60523 | $18K |
| DELTA DENTAL OF ARIZONA EIN 86-0274899 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $18K |
| CBIZ BENEFITS & INS SERVICES EIN 31-1582098 BROKER | Insurance agents and brokers Service code 22 | — | $16K |
| JORGENSEN HEALTHCARE ASSOCIATES INC EIN 86-0687859 EAP PROVIDER | Other services Service code 49 | — | $11K |
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 | 486 | 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) | 486 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 361 | $54K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 486 | $133K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 187 | $110K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 465 | $63K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 486 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 486 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.