| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $19K | $3K | $22K | 17.50% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 700 W. 47TH STREET, SUITE 1100 KANSAS CITY, MO 641121922 | AMERITAS LIFE INSURANCE CORP. | $3K | — | $3K | 3.57% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $8K | 12.70% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $2K | $10K | 17.90% |
| JENNIFER O'ROURKE3 | 8924 N. PALM BROOK DR. TUCSON, AZ 85743 | AFLAC | $8K | $259 | $8K | 15.13% |
| KEVIN DALE HARLOW3 Filed as: KEVIN HARLOW | 6281 N. ORACLE RD., UNIT 35072 TUCSON, AZ 85740 | AFLAC | $2K | $52 | $2K | 4.39% |
| ZAKERY HARLOW3 | 3755 N. BUSINESS CENTER DR. TUCSON, AZ 85705 | AFLAC | $2K | $52 | $2K | 3.33% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | P.O. BOX 632886 CINCINNATI, OH 45263 | AFLAC | $1K | — | $1K | 1.88% |
| JANELL R FRANK3 Filed as: JANELL R. FRANK | 7571 N RAE AVE TUCSON, AZ 85741 | AFLAC | $469 | — | $469 | 0.84% |
| H LARAINE OLIPHANT3 Filed as: H. LARAINE OLIPHANT | 3580 W. INA ROAD, SUITE 150 TUCSON, AZ 85741 | AFLAC | $423 | — | $423 | 0.76% |
| CATHERINE DAVIS3 | 9160 E. LOMA LINDA PLACE TUCSON, AZ 85749 | AFLAC | $115 | — | $115 | 0.21% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N. ORACLE ROAD 178 PMB 152 TUCSON, AZ 85704 | AFLAC | $106 | — | $106 | 0.19% |
| SCOTT WEBB3 | 2155 W. PINNACLE PEAK RD STE 205 PHOENIX, AZ 85027 | AFLAC | $91 | — | $91 | 0.16% |
| HEATHER DANIELLE HAWK3 | 2603 N. ORCHARD AVE UNIT A TUCSON, AZ 85712 | AFLAC | $61 | — | $61 | 0.11% |
| ERIC PEDERSON3 | 1600 W. UNIVERSITY AVE., SUITE 104 FLAGSTAFF, AZ 86001 | AFLAC | $54 | — | $54 | 0.10% |
| JERRY HOKE3 | 517 E. 3270 N LEHI, UT 84043 | AFLAC | $47 | — | $47 | 0.08% |
| DONALD GREEN3 | 1611 W. PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $47 | — | $47 | 0.08% |
| DANIEL TORGERSEN3 | 4917 E. 25TH ST. TUCSON, AZ 85711 | AFLAC | $46 | — | $46 | 0.08% |
| CHEYANNA SARFF3 | 10553 E. AVALON PARK ST. TUCSON, AZ 85747 | AFLAC | $43 | — | $43 | 0.08% |
| MARK HILL3 | P.O. BOX 85715 TUCSON, AZ 85754 | AFLAC | $38 | — | $38 | 0.07% |
| MARK HILL3 | 7673 N SUMMIT PASS PRESCOTT VALLEY, AZ 86315 | AFLAC | $34 | — | $34 | 0.06% |
| RACHEL DAY3 | 5533 E 24TH STREET TUCSON, AZ 85711 | AFLAC | $27 | — | $27 | 0.05% |
| KIMBERLY RODRIGUEZ3 | 37057 S. GAMBEL QUAIL DR. MARANA, AZ 85658 | AFLAC | $26 | — | $26 | 0.05% |
| CHAD P SCHNEIDER3 Filed as: CHAD SCHNEIDER | 14430 BENEFIT ST. APT. 308 SHERMAN OAKS, CA 91423 | AFLAC | $25 | — | $25 | 0.04% |
| JULIE KICKER3 | 719 E. COTTONWOOD LANE CASA GRANDE, AZ 85122 | AFLAC | $20 | — | $20 | 0.04% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | P.O. BOX 66766 TUCSON, AZ 85737 | AFLAC | $19 | — | $19 | 0.03% |
| JACK GATHINGS3 | 7235 S. GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $18 | — | $18 | 0.03% |
| ERIC PEDERSON3 | 2615 N 4TH ST. STE 1 FLAGSTAFF, AZ 86004 | AFLAC | $15 | — | $15 | 0.03% |
| BRENDA S O BERRY3 Filed as: BRENDA O. BERRY | P.O. BOX 688 THATCHER, AZ 85852 | AFLAC | $9 | — | $9 | 0.02% |
| JACOB C ECHOLS3 Filed as: JACOB ECHOLS | 3850 E. BASELINE RD., SUITE 118 MESA, AZ 85206 | AFLAC | $8 | — | $8 | 0.01% |
| NICHOLAS J DONIA3 Filed as: NICHOLAS DONIA | 103 W CALLE MANTILLA SAHUARITA, AZ 85629 | AFLAC | $6 | — | $6 | 0.01% |
| PREFERRED MARKETING CORP3 Filed as: PREFERRED MARKETING CORP. | 1194 E LAKEVIEW DR SAN TAN VALLEY, AZ 85143 | AFLAC | $5 | — | $5 | 0.01% |
| STELLA MAQUERA3 | 4002 E. ELMWOOD ST. TUCSON, AZ 85711 | AFLAC | $4 | — | $4 | 0.01% |
| MICHAEL G GLADNICK3 Filed as: MICHAEL G. GLADNICK | 3850 E. BASELINE RD. STE 116 MESA, AZ 85206 | AFLAC | $1 | — | $1 | 0.00% |
| NATALIE MALHAM3 | 3850 E. BASELINE RD. STE 116 MESA, AZ 85206 | AFLAC | $1 | — | $1 | 0.00% |
| JEFFERY S GIBSON3 Filed as: JEFFERY S. GIBSON | 14301 N. 87TH ST. STE 313 SCOTTSDALE, AZ 85260 | AFLAC | $1 | — | $1 | 0.00% |
| JEFFREY A KLEINMAN SR3 Filed as: JEFFREY A. KLEINMAN SR. | 3420 E. SHEA BLVD STE 168 PHOENIX, AZ 85028 | AFLAC | $1 | — | $1 | 0.00% |
| SHAWN HOLTORF3 | 6234 WEST DEHREND DR APT 1135 GLENDALE, AZ 85308 | AFLAC | $1 | — | $1 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 700 W. 47TH ST. STE 1100 KANSAS CITY, MO 641121922 | VISION SERVICE PLAN | $716 | — | $716 | 1.80% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | P.O. BOX 632886 CINCINNATI, OH 452632886 | EMPLOYERS DENTAL SERVICES | $3K | — | $3K | 7.97% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | P.O. BOX 632886 CINCINNATI, OH 452632886 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $486 | $2K | 12.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $122K |
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 | 547 | 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) | 547 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 547 | $117K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 547 | $123K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 471 | $74K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 124 | $184K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 471 | $66K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 471 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 547 | — |
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.