| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MAXOR ADMINISTRATIVE SERVICES5 | 5046 NORTH 12TH STREET PHOENIX, AZ 85016 | NATIONWIDE LIFE INSURANCE | $190K | — | $190K | — |
| UNITED CLAIMS SOLUTIONS LLC4 Filed as: UNITED CLAIMS SOLUTIONS | 9207 NORTH 10TH DRIVE PHOENIX, AZ 85021 | NATIONWIDE LIFE INSURANCE | $35K | — | $35K | — |
| POMEROY & POMEROY3 | 3134 NORTH 7TH STREET PHOENIX, AZ 85014 | NATIONWIDE LIFE INSURANCE | $29K | — | $29K | — |
| CAREWISE4 | 25500 COMMERCENTRE DRIVE LAKE FOREST, CA 92630 | NATIONWIDE LIFE INSURANCE | $8K | — | $8K | — |
| ARIZONA FOUNDATION4 | 326 EAST CORONADO RD PHOENIX, AZ 85004 | NATIONWIDE LIFE INSURANCE | $6K | — | $6K | — |
| MIDLANDS CHOICE4 | 8420 WEST DODGE ROAD SUITE 210 OMAHA, NE 68114 | NATIONWIDE LIFE INSURANCE | $4K | — | $4K | — |
| MANAGED CARE CONCEPTS4 | 416 DONNELL STREET ORANGE, TX 77630 | NATIONWIDE LIFE INSURANCE | $4K | — | $4K | — |
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 | 546 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 546 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | NATIONWIDE LIFE INSURANCE | 546 | $0 |
| Vision | NATIONWIDE LIFE INSURANCE | 546 | $0 |
| Life insurance | NATIONWIDE LIFE INSURANCE | 546 | $0 |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE | 546 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 546 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.