| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STOP LOSS INSURANCE SERVICES, INC.3 | 940 ADAMS ST STE G BENICIA, CA 94510 | HCC LIFE INSURANCE COMPANY | $44K | — | $44K | 3.09% |
| IBS INC3 | PO BOX 2579 APPLETON, WI 549122579 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | — | $8K | 2.51% |
| GORDON WILLIAMSON3 | PO BOX 2579 APPLETON, WI 549122579 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 0.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SOUTHWEST SERVICE ADMINISTRATORS EIN 86-0785790 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $9.6M |
| BLUECROSS BLUESHIELD OF AZ., INC. EIN 86-0004538 NONE | Other fees; Direct payment from the plan Service code 50 | — | $2.6M |
| OPTUM RX NONE | Other fees; Direct payment from the plan Service code 50 | 2300 MAIN ST IRVINE, CA 92614 | $595K |
| AMERICAN HEALTH GROUP NONE | Direct payment from the plan; Other fees Service code 50 | 2152 S VINEYARD STE 103 MESA, AZ 85210 | $522K |
| ACTIVE RADAR NONE | Other fees; Direct payment from the plan Service code 50 | 2 RICHMOND SQ STE 110 PROVIDENCE, RI 02906 | $311K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $309K |
| UNITED HEALTHCARE NONE | Other fees; Direct payment from the plan Service code 50 | 333 W VINE ST STE 500 LEXINGTON, KY 40507 | $246K |
| HEALTH MANAGEMENT CONCEPTS, INC. EIN 75-3189468 NONE | Direct payment from the plan; Other fees Service code 50 | — | $212K |
| RAEL & LETSON EIN 94-1701048 NONE | Consulting (general); Direct payment from the plan; Actuarial Service code 11 | — | $196K |
| TELADOC, INC. NONE | Other fees; Direct payment from the plan Service code 50 | 1945 LAKEPOINTE DR LEWISVILLE, TX 75057 | $166K |
| HEALTH MANAGEMENT SYSTEM, INC. NONE | Other fees; Direct payment from the plan Service code 50 | 900 CIRCLE 75 PKWY SE STE 650 ATLANTA, GA 30339 | $161K |
| VISION SERVICE PLAN EIN 23-7293853 NONE | Direct payment from the plan; Other fees Service code 50 | — | $139K |
| CIGNA HEALTH & LIFE INSURANCE CO. NONE | Other fees; Direct payment from the plan Service code 50 | 11001 N BLACK CYN HWY STE 300 PHOENIX, AZ 85029 | $122K |
| CREWS MACQUARRIE & ASSOCIATES, INC. NONE | Consulting (general); Actuarial; Direct payment from the plan Service code 11 | 2855 MICHELLE DR STE 100 IRVINE, CA 92606 | $113K |
| NATIONAL INVESTMENT SERVICES, INC. EIN 80-0169636 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $112K |
| REINHART BOERNER VAN DEUREN, S.C. EIN 39-1126909 NONE | Legal; Direct payment from the plan Service code 29 | — | $109K |
| MCCRACKEN STEMERMAN & HOLSBERRY LLP EIN 94-1709555 NONE | Legal; Direct payment from the plan Service code 29 | — | $106K |
| BLUECROSS BLUESHIELD OF IL., INC. NONE | Direct payment from the plan; Other fees Service code 50 | 300 E RANDOLPH ST CHICAGO, IL 606015099 | $87K |
| TOTAL DENTAL ADMINISTRATORS NONE | Direct payment from the plan; Other fees Service code 50 | 2111 E HIGHLAND AVE STE 250 PHOENIX, AZ 85016 | $84K |
| UNITED CONCORDIA, INC EIN 95-4146179 NONE | Other fees; Direct payment from the plan Service code 50 | — | $72K |
| HORIZON ACTUARIAL SERVICES NONE | Actuarial; Direct payment from the plan; Consulting (general) Service code 11 | 420 EXCHANGE STE 260 IRVINE, CA 92602 | $61K |
| THE SEGAL COMPANY, WESTERN STATES EIN 94-1503999 NONE | Consulting fees; Consulting (general); Direct payment from the plan Service code 16 | — | $30K |
| CIGNA OUT OF NETWORK SAVINGS NONE | Other fees; Direct payment from the plan Service code 50 | PO BOX 981706 EL PASO, TX 79998 | $24K |
| BANK OF AMERICA EIN 86-0005300 NONE | Other fees; Direct payment from the plan Service code 50 | — | $19K |
| NEW ENGLAND PENSION CONSULTANTS EIN 04-2927339 NONE | Other fees; Investment advisory (plan) Service code 27 | — | $16K |
| WILKINSON BENEFIT CONSULTANTS NONE | Consulting fees; Direct payment from the plan; Consulting (general) Service code 16 | 1812 W BURBANK BLVD STE 143 BURBANK, CA 91506 | $8K |
| THE NORTHERN TRUST EIN 39-1561860 NONE | Direct payment from the plan; Other services; Float revenue; Custodial (securities) Service code 19 | — | $5K |
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 | 17,321 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 17,321 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(4 contracts, 4 carriers) | ALPHA DENTAL OF ARIZONA, INC. | 2,428 | $424K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 41,560 | $316K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 16,624 | $1.4M |
| Other(3 contracts, 3 carriers) | HEALTH MANAGEMENT CONCEPTS,INC. | 41,560 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 41,560 | — |
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."
No prospect flags tripped on this filing.