| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| APRIL L FARRELL3 | 4809 WEST TULSA STREET CHANDLER, AZ 85226 | AFLAC | $5K | — | $5K | 8.64% |
| DANIEL SALDIVAR JR3 | 433 KITTY HAWK DRIVE BUILDING 2 SUITE 215 UNIVERSAL CITY, TX 78148 | AFLAC | $2K | — | $2K | 3.65% |
| MICHAEL W. POWER3 Filed as: MICHAEL W POWER | 3427 PECAN GAP SAN ANTONIO, TX 78247 | AFLAC | $2K | — | $2K | 2.93% |
| DENISE JANE FORCONI3 | 30411 NORTH 72ND PLACE SCOTTSDALE, AZ 85266 | AFLAC | $1K | — | $1K | 2.28% |
| JEFFERY S GIBSON3 | 4805 LAKE BROOK DRIVE SUITE 220 GLEN ALLEN, VA 23060 | AFLAC | $596 | — | $596 | 1.14% |
| PATRICIA J GEE3 | P.O. BOX 2334 MESA, AZ 85214 | AFLAC | $440 | — | $440 | 0.84% |
| BRENT FORD3 Filed as: BRENT A FORD | 40 NE LOOP 410 SUITE 408 SAN ANTONIO, TX 78216 | AFLAC | $414 | — | $414 | 0.79% |
| MARVIN LEE WILKERSON3 | 884 HOLLY TREE GAP ROAD BRENTWOOD, TN 37027 | AFLAC | $210 | — | $210 | 0.40% |
| BRITTON JOHNSON3 Filed as: BRITTON L JOHNSON | 1069 WEST BROAD STREET FALLS CHURCH, VA 22046 | AFLAC | $154 | — | $154 | 0.29% |
| M JEAN HEMP3 | P.O. BOX 41292 MESA, AZ 85274 | AFLAC | $75 | — | $75 | 0.14% |
| NICHOLAS E VIGIL3 | 120 ROCKBOLT CIRCLE FOLSOM, CA 95630 | AFLAC | $67 | — | $67 | 0.13% |
| MICHAEL L BRAUN3 | 1718 DEVOE DRIVE LINCOLN, NE 68506 | AFLAC | $56 | — | $56 | 0.11% |
| SCOTT WEBB3 | 2155 WEST PINNACLE PEAK ROAD SUITE 205 PHOENIX, AZ 85027 | AFLAC | $52 | — | $52 | 0.10% |
| MERLE DALE HALL3 | 950 WEST BANNOCK STREET SUITE 1100 BOISE, ID 83702 | AFLAC | $46 | — | $46 | 0.09% |
| GARY A YARBROUGH3 | 1436 NORTH HIGLEY ROAD SUITE 100 GILBERT, AZ 85234 | AFLAC | $40 | — | $40 | 0.08% |
| ORIN LEE WILLIAMS3 | 313 NORTH CORRINE DRIVE GILBERT, AZ 85234 | AFLAC | $34 | — | $34 | 0.06% |
| PREFERRED MARKETING CORP3 | 1194 EAST LAKEVIEW DRIVE SAN TAN VALLEY, AZ 85143 | AFLAC | $28 | — | $28 | 0.05% |
| GREGORY F STENZEL3 | 2302 KNOX WAY MELISSA, TX 75454 | AFLAC | $26 | — | $26 | 0.05% |
| EFRAIN RENE DIAZ3 | 6287 EAST AVALON DRIVE SCOTTSDALE, AZ 85251 | AFLAC | $21 | — | $21 | 0.04% |
| DENNIS W CAMDEN3 | 715 NORTH KENTUCKY STREET MEXICO, MO 65265 | AFLAC | $18 | — | $18 | 0.03% |
| GREGORY J WEEKS3 | 1259 LOOP 337 2ND FLOOR NEW BRAUNFELS, TX 78130 | AFLAC | $6 | — | $6 | 0.01% |
| NATALIE MALHAM3 | 3850 EAST BASELINE ROAD SUITE 116 MESA, AZ 85206 | AFLAC | $5 | — | $5 | 0.01% |
| MICHAEL G GLADNICK3 | 3850 EAST BASELINE ROAD SUITE 116 MESA, AZ 85206 | AFLAC | $5 | — | $5 | 0.01% |
| HEATHER F SEIBERT3 | P.O. BOX 1329 SHINER, TX 77984 | AFLAC | $3 | — | $3 | 0.01% |
| THE JAMES B OSWALD COMPANY3 Filed as: JAMES ROBERT BLAKEY | 14234 SAVANNAH PASS SAN ANTONIO, TX 78216 | AFLAC | $3 | — | $3 | 0.01% |
| MICHAEL G RYAN3 | 836 HOOSIER PASS PRESCOTT, AZ 86301 | AFLAC | $2 | — | $2 | 0.00% |
| LAUREL L HARLOW3 | 3755 NORTH BUSINESS CENTRE DRIVE SUITE 4 TUCSON, AZ 85705 | AFLAC | $1 | — | $1 | 0.00% |
| JEFFREY A KLEINMAN SR3 | 3420 EAST SHEA BOULEVARD SUITE 168 PHOENIX, AZ 85028 | AFLAC | $1 | — | $1 | 0.00% |
| TIMOTHY MARTIN3 Filed as: TIMOTHY I MARTIN | 20516 NORTH 80TH LANE PEORIA, AZ 85382 | AFLAC | $1 | — | $1 | 0.00% |
| SHAWN HOLTORF3 | 5522 WEST NORTHWOOD DRIVE GLENDALE, AZ 85310 | AFLAC | $1 | — | $1 | 0.00% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 50435 INDIANAPOLIS, IN 462500435 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 12.00% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAS WEST DRIVE SUITE 100 INDIANAPOLIS, IN 46240 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | P.O. BOX 50435 INDIANAPOLIS, IN 46250 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $928 | — | $928 | 8.43% |
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 | 128 | 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) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 148 | $11K |
| Life insurance | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 136 | $31K |
| Short-term disability | AFLAC | 74 | $52K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 32 | $12K |
| Other | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 136 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.