| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | PO BOX 632886 CINCINNATI, OH 452632886 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27K | $496 | $28K | 6.38% |
| BST COMPANIES INC3 Filed as: BST COMPANIES | 481 EAST DOWNTOWN STREET TUCSON, AZ 85701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17K | $2K | $18K | 4.29% |
| R AND T FIGUEROA LLC3 Filed as: R&T FIGUEROA | 7569 S CARLISLE AVE TUCSON, AZ 85746 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $908 | $10K | 2.30% |
| JB & H LLC3 Filed as: JB&H LLC | 8707 E SAGUARO VIEW PLACE VAIL, AZ 85641 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $206 | $7K | 1.65% |
| PAUL A BYNUM3 | PO BOX 12306 TUCSON, AZ 85732 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $18 | $4K | 0.91% |
| LORENZA TORRES3 | 9636 E PASEO SAN BERNARDO DRIVE TUCSON, AL 85747 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $100 | $3K | 0.66% |
| EC BENEFITS INC3 | 5205 EAST PIMA STREET TUCSON, AZ 85712 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 0.51% |
| VINCENT TAYLOR ECHOLS3 | PO BOX 594 THATCHER, AZ 85552 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $293 | $2K | 0.50% |
| CAROL JEAN HALL3 | PO BOX 15158 TUCSON, AZ 85708 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $125 | $2K | 0.47% |
| JULIE ANN MEADE3 Filed as: JULIE MEADE | 63 REGENCY PLACE HAYWARD, CA 94544 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.30% |
| JOSEPH QUINTANA3 | 14602 N 7TH PLACE PHOENIX, AZ 85022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $203 | — | $203 | 0.05% |
| LUIS ENRIQUE VALDEZ3 | 6515 S STAR RIDGE PLACE TUCSON, AZ 85757 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | — | $102 | 0.02% |
| DEBORAH ANN BERRY3 | 1042 E 9TH PLACE MESA, AL 85203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | — | $49 | 0.01% |
| DEBORAH KNICKERBOCKER3 | PO BOX 823 CORTARO, AZ 85652 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.00% |
| LEED AND LEED, INC3 Filed as: LEED AND LEED INC | 1889 N KOLB ROAD TUCSON, AZ 85715 | STANDARD INSURANCE COMPANY | $27K | — | $27K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 1440 TOMAHAWK CREEK PARKWAY LEAWOOD, KS 66211 | BLUE CROSS BLUE SHIELD OF ARIZONA | $76K | — | $76K | 42.86% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | DELTA DENTAL OF ARIZONA | $5K | — | $5K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | — | $8K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | DELTA DENTAL OF ARIZONA | $3K | — | $3K | 4.65% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $4K | — | $4K | 7.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $3K | — | $3K | 8.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $60 | — | $60 | 10.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13 | — | $13 | 9.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $302K |
| AMERICAN SPECIALTY HEALTH NETWORK EIN 33-0938349 CHIROPRACTIC PROVIDER | Other fees Service code 99 | — | $0 |
| BIODYNE EIN 94-3056223 MENTAL HEALTH PROVIDER | Other fees Service code 99 | — | $0 |
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 | 421 | 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) | 421 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 421 | $176K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF ARIZONA | 335 | $211K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 697 | $226K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 762 | $599 |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 356 | $431K |
| Long-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 762 | $354K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 421 | $176K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF ARIZONA | 421 | $176K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 762 | $133 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 762 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.