| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURICA, INC.3 Filed as: INSURICA SOUTHWEST INS SVCS LLC | 4646 EAST VAN BUREN STREET SUITE 310 PHOENIX, AZ 85008 | BLUE CROSS BLUE SHIELD OF ARIZONA | $61K | — | $61K | 4.80% |
| INSURICA, INC.3 Filed as: INSURICA SOUTHWEST INSURANCE SERVIC | 4686 EAST VAN BUREN STREET PHOENIX, AZ 85008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20K | $3K | $23K | 10.25% |
| NAOMI BERG3 | 5338 EAST GELDING DRIVE SCOTTSDALE, AZ 85254 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $3K | $13K | 5.80% |
| STEVEN ROBERT KURZ3 | 14640 NORTH 90TH DRIVE PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $4K | $6K | 2.75% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 Filed as: KURZ & VALDEZ BENEFITS ENROLLMENT S | 8601 NORTH BLACK CANYON HIGHWAY SUITE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $2K | $3K | 1.49% |
| KELLIE GREENE VALDEZ3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 1.40% |
| MARLEN LONG3 | 4955 SOUTH DURANGO DRIVE SUITE 209M LAS VEGAS, NV 89113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $754 | $2K | $3K | 1.37% |
| R AND T FIGUEROA LLC3 | 7569 SOUTH CARLISLE AVENUE TUCSON, AZ 85746 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $169 | $2K | 0.73% |
| SANDRA STOKELY3 | 4650 RANCH HOUSE ROAD UNIT 107 NORTH LAS VEGAS, NV 89031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $47 | $2K | 0.71% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DRIVE UNIT 1503 CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $312 | $1K | 0.60% |
| RENE ADRIAN RODRIGUEZ3 | 1814 EAST BELL ROAD APARTMENT 2009 PHOENIX, AZ 85022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $72 | $1K | 0.60% |
| KATERINA MARTINEZ3 | 3800 DALECREST DRIVE UNIT 2012 LAS VEGAS, NV 89129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $324 | $772 | $1K | 0.48% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $884 | $200 | $1K | 0.48% |
| LUIS DANIEL RIVAS3 | 8603 WEST GOLDEN LANE PEORIA, AZ 85345 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $748 | — | $748 | 0.33% |
| SENECA ALEJANDRO LUJAN3 | 1107 EAST ORCHID LANE PHOENIX, AZ 85020 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $696 | — | $696 | 0.31% |
| LORENZA TORRES3 | 9636 EAST PASEO SAN BERNARDO TUCSON, AZ 85747 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $553 | $31 | $584 | 0.26% |
| BRENT DEVARAM BUFFONE3 | 3512 EAST CARTIER AVENUE NORTH LAS VEGAS, NV 89030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $359 | $107 | $466 | 0.21% |
| V VENTURES LLC3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $175 | $261 | $436 | 0.19% |
| ISIDORO ZEICHNER3 | 1611 HUNTINGTON DRIVE APARTMENT 7 SOUTH PASADENA, CA 91030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $339 | $1 | $340 | 0.15% |
| PECK FINANCIAL SERVICES INC3 | 27566 NORTH 98TH LANE PEORIA, AZ 85383 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $320 | $17 | $337 | 0.15% |
| CARLOS D ESPINOSA3 Filed as: CARLOS ESPINOSA | 10940 NORTH MARTINEAU ROAD ELFRIDA, AZ 85610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $252 | $21 | $273 | 0.12% |
| ANNALISA MARIE KURZ3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $136 | $102 | $238 | 0.10% |
| MIRANDELLY HERNANDEZ3 | 16055 WEST SHANGRI LA ROAD SURPRISE, AZ 85379 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $210 | $9 | $219 | 0.10% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE STREET SUITE 340 NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $73 | $132 | $205 | 0.09% |
| EDUARDO BARAJAS3 | 3532 WEST GLASS LANE PHOENIX, AZ 85041 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $176 | — | $176 | 0.08% |
| JB & H LLC3 | 8707 EAST SAGUARDO VIEW PLACE VAIL, AZ 85641 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | — | $103 | 0.05% |
| TINA HERNANDEZ3 | 11779 WEST COCOPAH STREET AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $73 | $24 | $97 | 0.04% |
| ANDREA XENNY COURTNEY3 | 326 WEST GRANT STREET SPEARFISH, SD 57783 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | $60 | $96 | 0.04% |
| JAMES BELL3 | 540 BONAIR PLACE LA JOLLA, CA 92037 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | $5 | $84 | 0.04% |
| KENT BISWANGER3 | 17010 SOUTH 32ND PLACE PHOENIX, AZ 85048 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | — | $79 | 0.03% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | $22 | $70 | 0.03% |
| JAMES D THRESHER3 | PO BOX 19569 HAPPY JACK, AZ 86024 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.01% |
| MERI HOWARD3 | 8465 WEST SAHARA AVENUE # 111-308 LAS VEGAS, NV 89117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.01% |
| SILVIA AGUILAR ALVISO3 | 5809 ALIMAR DRIVE LAS VEGAS, NV 89130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.01% |
| NOAH OROPEZA3 | 5305 NORTH GINNING DRIVE LITCHFIELD PARK, AZ 85340 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $9 | $22 | 0.01% |
| CHRISTIAN BARAJAS3 | 3842 WEST CHOLLA STREET PHOENIX, AZ 85029 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.01% |
| CAROL JEAN HALL3 | 5737 EAST CHAPTER DRIVE TUCSON, AZ 85708 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.00% |
| MELISSA ALEXANDRIA BIBBEE3 | 6950 WEST ROWEL ROAD PEORIA, AZ 85383 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.00% |
| KARA SANCHEZ3 | 1 GRAMPTON COURT LIVERPOOL, NY 13090 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| NAOMI BERG3 | 5338 EAST GELDING DRIVE SCOTTSDALE, AZ 85254 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $947 | $3K | 10.05% |
| YESENIA A SANCHEZ3 | 1021 DELRIDGE AVENUE ORLANDO, FL 32804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $914 | $77 | $991 | 2.92% |
| INSURICA, INC.3 Filed as: INSURICA SOUTHWEST INSURANCE SERVIC | 4686 EAST VAN BUREN STREET PHOENIX, AZ 85008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $755 | $198 | $953 | 2.81% |
| LIZBETH RAMON3 | 16128 APPENNINE DRIVE BROOKSVILLE, FL 34601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $730 | $168 | $898 | 2.64% |
| KELLIE GREENE VALDEZ3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $462 | $363 | $825 | 2.43% |
| STEVEN ROBERT KURZ3 | 14640 NORTH 90TH DRIVE PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $197 | $396 | $593 | 1.75% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 | 8601 NORTH BLACK CANYON HIGHWAY SUITE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $209 | $367 | $576 | 1.70% |
| V VENTURES LLC3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | $78 | $130 | 0.38% |
| WILLIAM RENNARD3 | 3001 ALOMA AVENUE SUITE 116 WINTER PARK, FL 32792 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | $38 | $102 | 0.30% |
| CALVON Y BUCZKOWSKI3 | 204 COVERED BRIDGE DRIVE OCOEE, FL 34761 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | $46 | $98 | 0.29% |
| WORKSITE BENEFITS SOLUTION LLC3 | 2622 WYMAN CIRCLE KISSIMMEE, FL 34744 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | $37 | $89 | 0.26% |
| NORWOOD BENEFIT SERVICES INC3 | 6478 LONG BREEZE ROAD ORLANDO, FL 32810 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | $12 | $76 | 0.22% |
| ANNALISA MARIE KURZ3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | $28 | $65 | 0.19% |
| PECK FINANCIAL SERVICES INC3 | 27566 NORTH 98TH LANE PEORIA, AZ 85383 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | $3 | $42 | 0.12% |
| NAOMI BERG3 | 5338 EAST GELDING DRIVE SCOTTSDALE, AZ 85254 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $688 | $2K | 12.90% |
| INSURICA, INC.3 Filed as: INSURICA SOUTHWEST INSURANCE SERVIC | 4686 EAST VAN BUREN STREET PHOENIX, AZ 85008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $368 | $2K | 9.29% |
| RENE ADRIAN RODRIGUEZ3 | 1814 EAST BELL ROAD APARTMENT 2009 PHOENIX, AZ 85022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $78 | $1K | 7.48% |
| STEVEN ROBERT KURZ3 | 14640 NORTH 90TH DRIVE PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $334 | $668 | $1K | 5.21% |
| KELLIE GREENE VALDEZ3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $538 | $422 | $960 | 4.99% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 | 8601 NORTH BLACK CANYON HIGHWAY SUITE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $315 | $552 | $867 | 4.51% |
| V VENTURES LLC3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $136 | $205 | $341 | 1.77% |
| ANNALISA MARIE KURZ3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $99 | $75 | $174 | 0.90% |
| PECK FINANCIAL SERVICES INC3 | 27566 NORTH 98TH LANE PEORIA, AZ 85383 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | $3 | $47 | 0.24% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.02% |
| STEVEN ROBERT KURZ3 | 14640 NORTH 90TH DRIVE PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $602 | $1K | $2K | 19.27% |
| NAOMI BERG3 | 5338 EAST GELDING DRIVE SCOTTSDALE, AZ 85254 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $412 | $1K | 15.82% |
| INSURICA, INC.3 Filed as: INSURICA SOUTHWEST INSURANCE SERVIC | 4686 EAST VAN BUREN STREET PHOENIX, AZ 85008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $757 | $199 | $956 | 10.19% |
| ISIDORO ZEICHNER3 | 1611 HUNTINGTON DRIVE APARTMENT 7 SOUTH PASADENA, CA 91030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $571 | $1 | $572 | 6.10% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 | 8601 NORTH BLACK CANYON HIGHWAY SUITE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $176 | $308 | $484 | 5.16% |
| KELLIE GREENE VALDEZ3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $269 | $211 | $480 | 5.12% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $81 | $36 | $117 | 1.25% |
| V VENTURES LLC3 | 8470 WEST CHARLESTON AVENUE PEORIA, AA 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $40 | $67 | 0.71% |
| MELODY ANN OVERLAND3 | 7009 WEST MCMAHON WAY PEORIA, AZ 85345 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | $6 | $54 | 0.58% |
| PECK FINANCIAL SERVICES INC3 | 27566 NORTH 98TH LANE PEORIA, AZ 85383 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $2 | $29 | 0.31% |
| MARIA LOZANO3 | 4124 EAST VEST AVENUE GILBERT, AZ 85295 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.29% |
| INSURICA, INC.3 Filed as: INSURICA SOUTHWEST INSURANCE SERVIC | 4686 EAST VAN VUREN STREET PHOENIX, AZ 85008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $624 | $81 | $705 | 10.35% |
| NAOMI BERG3 | 5338 EAST GELDING DRIVE SCOTTSDALE, AZ 85254 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $358 | $115 | $473 | 6.94% |
| RENE ADRIAN RODRIGUEZ3 | 1814 EAST BELL ROAD APARTMENT 2009 PHOENIX, AZ 85022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $355 | $20 | $375 | 5.51% |
| KURZ & VALDEZ BENEFIT ENROLLMENT SO3 | 8601 NORTH BLACK CANYON HIGHWAY SUITE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $97 | $167 | $264 | 3.88% |
| KELLIE GREENE VALDEZ3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | $74 | $168 | 2.47% |
| MARIA LOZANO3 | 4124 EAST VEST AVENUE GILBERT, AZ 85295 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | — | $86 | 1.26% |
| STEVEN ROBERT KURZ3 | 14640 NORTH 90TH DRIVE PEORIA, AZ 85381 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $43 | $70 | 1.03% |
| V VENTURES LLC3 | 8470 WEST CHARLESTON AVENUE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $15 | $25 | 0.37% |
| PECK FINANCIAL SERVICES INC3 | 27566 NORTH 98TH LANE PEORIA, AZ 85383 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $1 | $15 | 0.22% |
| JB & H LLC3 | 8707 EAST SAGUARDO VIEW PLACE VAIL, AZ 85641 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.22% |
| KENT BISWANGER3 | 17010 SOUTH 32ND PLACE PHOENIX, AZ 85048 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.10% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 NORTH BLACK CANYON HIGHWAY SUITE 20 PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.09% |
| MIRANDELLY HERNANDEZ3 | 16055 WEST SHANGRI LA ROAD SURPRISE, AZ 85379 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.06% |
| JAMES D THRESHER3 | PO BOX 19569 HAPPY JACK, AZ 86024 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.06% |
| R AND T FIGUEROA LLC3 | 7569 SOUTH CARLISLE AVENUE TUCSON, AZ 85746 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.04% |
No Schedule C service providers reported on this filing.
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 | 300 | 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) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 282 | $1.3M |
| Dental(5 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 211 | $296K |
| Vision(5 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 211 | $296K |
| Short-term disability(5 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 211 | $296K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 282 | $1.3M |
| Other(5 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 211 | $296K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 282 | — |
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.