| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK J MATSOCK3 Filed as: MARK J. MATSOCK | 5110 N 40TH STREET SUITE 242 PHOENIX, AZ 85018 | KAISER FOUNDATION HEALTH PLAN, INC. | $40K | — | $40K | 1.92% |
| MARK METTILLE3 Filed as: MARK J. MATSOCK & ASSOCIATES INC. | 5110 N 40TH STREET SUITE 242 PHOENIX, AZ 85018 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $16K | — | $16K | 9.89% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP INC. | 5110 N 40TH STREET SUITE 234 PHOENIX, AZ 85018 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $8K | $8K | 4.94% |
| MARK J MATSOCK3 Filed as: MARK J. MATSOCK | 5110 N 40TH STREET SUITE 242 PHOENIX, AZ 85018 | VISION SERVICE PLAN | $1K | — | $1K | 5.49% |
| MARK METTILLE3 Filed as: MARK J. MATSOCK & ASSOCIATES INC. | 5110 N 40TH STREET SUITE 242 PHOENIX, AZ 85018 | CIGNA DENTAL HEALTH OF CALIFORNIA, INC. | $855 | — | $855 | 10.00% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP INC. | 5110 N 40TH STREET SUITE 234 PHOENIX, AZ 85018 | CIGNA DENTAL HEALTH OF CALIFORNIA, INC. | — | $428 | $428 | 5.01% |
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 | 301 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 301 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 301 | $2.1M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 250 | $166K |
| Vision | VISION SERVICE PLAN | 156 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 301 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.