| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOVITT AND TOUCHE, INC.3 Filed as: LOVITT TOUCHE INC | PO BOX 32702 TUCSON, AZ 857512702 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $1K | $4K | 5.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 CLAIMS ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $82K |
| JORGENSEN HEALTHCARE ASSOCIATES INC EIN 86-0687859 SERVICE PROVIDER | Other services Service code 49 | — | $7K |
| AMERICAN SPECIALTY HEALTH SYSTEMS EIN 33-0938349 SERVICE PROVIDER | Other services Service code 49 | — | $6K |
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 | 106 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 96 | $294K |
| Dental | DELTA DENTAL OF ARIZONA | 96 | $81K |
| Vision | BLUE CROSS BLUE SHIELD OF ARIZONA | 96 | $294K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 168 | $81K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 168 | $81K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 168 | $81K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 96 | $294K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF ARIZONA | 96 | $294K |
| Other(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 168 | $375K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 168 | — |
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.