| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | PO BOX 632886 CINCINNATI, OH 45263 | AMERITAS LIFE INSURANCE CORP. | $8K | $385 | $9K | 10.47% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 10.84% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 12.50% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | 700 W 47TH ST STE 100 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $7K | 19.16% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $1K | — | $1K | 5.57% |
| STEVEN ROBERT KURZ3 | 14640 N 90TH DR PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $550 | $1K | $2K | 15.67% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC. | 700 W. 47TH ST. KANSAS CITY, MO 64112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $768 | — | $768 | 7.34% |
| KELLIE GREENE VALDEZ3 | 8470 W CHARLESTON AVE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $294 | $212 | $506 | 4.83% |
| V VENTURES LLC3 | 8470 W CHARLESTON AVE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $198 | $284 | $482 | 4.60% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 Filed as: KURZ & VALDEZ BENEFIT ENROLLMENT | 8601 N BLACK CANYON HWY STE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $146 | $160 | $306 | 2.92% |
| JAMES BELL3 | 540 BONAIR PL LA JOLLA, CA 92037 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $160 | $11 | $171 | 1.63% |
| MARINA C LOVE3 Filed as: MARINA LOVE | 406 HOPKINS ST RIO RICO, AK 85648 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | — | $79 | 0.75% |
| DONNA MARIE STOLL3 | 502 BOB LITTLE RD. PARAMA CITY, FL 32404 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | — | $62 | 0.59% |
| ANNALISA MARIE KURZ3 | 8601 N BLACK CANYON HWY PHOENIX, AZ 85201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $6 | $39 | 0.37% |
| BST COMPANIES INC3 Filed as: BST COMPANIES INC. | 319 N CAMERON VIEW PLACE TUCSON, AK 85745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.35% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 N BLACK CANYON HWY PHOENIX, AK 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.26% |
| VINCENT TAYLOR ECHOLS3 | PO BOX 594 THATCHER, AZ 85552 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.09% |
| CASSANDRA EPSTEIN3 | 13874 CARLOW PARK DR. RIVERVIEW, FL 33579 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.05% |
| EC BENEFITS INC3 Filed as: EC BENEFITS | 8038 S 38TH PL PHOENIX, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.04% |
| JOSEPH QUINTANA3 | 3022 N 49TH CT PHOENIX, AZ 85018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $112K |
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 | 336 | 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) | 336 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 336 | $82K |
| Vision | VISION SERVICE PLAN | 151 | $20K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 207 | $80K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 11 | $10K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 207 | $61K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 207 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 336 | — |
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.