| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP | — | BERKLEY LIFE AND HEALTH INSURANCE CO. | — | $13K | $13K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA INC | PO BOX 730054 DALLAS, TX 75373 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA INC | PO BOX 730054 DALLAS, TX 75373 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA | 16220 N SCOTTSDALE RD SCOTTSDALE, AZ 85254 | AVESIS INSURANCE INCORPORATED | $1K | — | $1K | 9.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA INC | PO BOX 730054 DALLAS, TX 75373 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $429 | — | $429 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASHTON TIFFANY EIN 86-0804559 PLAN ADMINISTRATOR | Contract Administrator Service code 13 | — | $300K |
| AMERIBEN IEC GROUP EIN 82-0497661 N/A | Claims processing Service code 12 | — | $138K |
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0489999 N/A | Insurance services Service code 23 | — | $87K |
| WILLIS OF ARIZONA EIN 86-0223854 LEGAL | Legal Service code 29 | — | $60K |
| DELTA DENTAL OF ARIZONA EIN 86-0274899 INSURANCE ADMINISTRATOR | Insurance services Service code 23 | — | $18K |
| MULTIPLAN EIN 13-3068979 N/A | Other fees Service code 99 | — | $17K |
| ALLIANT INSURANCE SERVICES EIN 33-0785439 INSURANCE SERVICES | Insurance services Service code 23 | — | $12K |
| ONSAGER WERNER & OBERG PLC EIN 86-0960805 LEGAL | Legal Service code 29 | — | $11K |
| HEALTH EQUITY EIN 52-2383166 N/A | Other fees Service code 99 | — | $8K |
| CERIDIAN HCM, INC. EIN 59-3228107 EMPLOYEE ASSISTANCE PROG | Other fees Service code 99 | — | $7K |
| SPECIALIZED OFFICE SYSTEMS, INC. EIN 86-0634590 N/A | Other fees Service code 99 | — | $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 | 388 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 389 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 666 | $80K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 216 | $28K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 569 | $88K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 390 | $70K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE AND HEALTH INSURANCE CO. | 666 | $250K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 72 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 666 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.