| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT INTELLIGENCE INC3 Filed as: BENEFIT INTELLIGENCE INC. | 4862 E BASELINE RD. SUITE 101 MESA, AZ 85206 | METROPOLITAN LIFE INSURANCE COMPANY | $17K | — | $17K | 6.38% |
| GREGG FENDLEY BENEFITS INC3 Filed as: GREGG FENDLEY BENEFITS INC. | 940 N. SWITZER CANYON DR. #202 FLAGSTAFF, AZ 86001 | METROPOLITAN LIFE INSURANCE COMPANY | $409 | — | $409 | 0.16% |
| JAMES JOBLON JR3 | 518 W WHITE MOUNTAIN BLVD LAKESIDE, AZ 85928 | AFLAC | $2K | $142 | $2K | 4.94% |
| RICA GIRARDI3 | 5346 BRANDING IRON LOOP PINETOP, AZ 85935 | AFLAC | $964 | $55 | $1K | 2.74% |
| MARK HILL3 | PO BOX 85716 TUCSON, AZ 86764 | AFLAC | $392 | $56 | $448 | 1.21% |
| MISSY LEFFLER3 | 457 S 98TH PL MESA, AZ 85208 | AFLAC | $272 | — | $272 | 0.73% |
| SCOTT WEBB3 | 2355 W PINNACLE PEAK RD STE 380 PHOENIX, AZ 85027 | AFLAC | $205 | $49 | $254 | 0.68% |
| SUZANNE ROWE3 | 900 S IDAHO RD LOT 37 APACHE JUNCTION, AZ 85119 | AFLAC | $210 | — | $210 | 0.57% |
| MICHAEL TODD3 | 518 W WHITE MOUNTAIN BLVD LAKESIDE, AZ 85929 | AFLAC | $101 | $97 | $198 | 0.53% |
| RICK GOODMAN3 | PO BOX 42 SHOW LOW, AZ 85902 | AFLAC | $153 | — | $153 | 0.41% |
| LANCE POWELL SR3 | 780 N 6TH AVE SHOW LOW, AZ 85901 | AFLAC | $149 | — | $149 | 0.40% |
| BENEFIT INTELLIGENCE INC3 Filed as: BENEFIT INTELLIGENCE GMI INC. | 4662 E. BASELINE RD STE 101 MESA, AZ 85206 | AFLAC | $121 | — | $121 | 0.33% |
| ERIC PEDERSON3 | 2615 N 4TH ST STE 1 FLAGSTAFF, AZ 86004 | AFLAC | $100 | — | $100 | 0.27% |
| WILLIAM H LENBERG3 Filed as: WILLIAM LENBERG | 10920 FAROLA DR NW ALBUQUERQUE, NM 87114 | AFLAC | $75 | — | $75 | 0.20% |
| JAMES HUNT3 | 15010 N 61ST PL SCOTTSDALE, AZ 85254 | AFLAC | $50 | — | $50 | 0.13% |
| MATTHEW MONK3 | PO BOX 3205 SHOW LOW, AZ 85902 | AFLAC | $44 | — | $44 | 0.12% |
| JACOB C ECHOLS3 Filed as: JACOB ECHOLS | 3850 E BASELINE RD STE 116 MESA, AZ 85206 | AFLAC | $43 | — | $43 | 0.12% |
| J M ELLWOOD3 Filed as: J. ELLWOOD | 8220 E SAN MIGUEL AVE SCOTTSDALE, AZ 85250 | AFLAC | $40 | — | $40 | 0.11% |
| PREFERRED MARKETING CORP3 | 1184 E LAKEVIEW DR SAN TAN VALLEY, AZ 85143 | AFLAC | $39 | — | $39 | 0.10% |
| TOM KOCH3 | 34 TAMARRON CLIFFS ST LAS VEGAS, NV 89148 | AFLAC | $39 | — | $39 | 0.10% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 N ORACLE RD 178 PMB 152 TUCSON, AZ 85704 | AFLAC | $28 | — | $28 | 0.08% |
| BENEFIT INTELLIGENCE INC3 | 4662 E BASELINE ROAD #101 MESA, AZ 85202 | AFLAC | $27 | — | $27 | 0.07% |
| DONALD GREEN3 | 1811 W PLACITA GARBO GREEN VALLEY, AZ 85822 | AFLAC | $8 | — | $8 | 0.02% |
| GEORGANNE JANNENGA3 | 2381 W PIONEER CT SHOW LOW, AZ 85901 | AFLAC | $8 | — | $8 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SUMMIT ADMINISTRATION SERVICES, INC EIN 86-0836639 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | 14646 N KIERLAND BLVD. SUITE 200 SCOTTSDALE, AZ 85254 | $44K |
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 PROVIDER NETWORK ACCESS | Other fees Service code 99 | 2444 WEST PALOMAS DRIVE PHOENIX, AZ 85002 | $30K |
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 | 153 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 678 | $263K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 678 | $263K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 678 | $263K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 678 | $263K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 678 | $263K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 153 | $329K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 678 | $300K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 678 | — |
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.