| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHEA INSURANCE LLC3 | 5510 S. FORT APACHE RD. LAS VEGAS, NV 89148 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $10K | $0 | $10K | 8.00% |
| SHEA INSURANCE LLC3 | 5510 S FORT APACHE RD LAS VEGAS, NV 89148 | ANTHEM LIFE INSURANCE COMPANY | $11K | $0 | $11K | 15.03% |
| D'ANN DABELL4 | 1174 N 2000 E LAYTON, UT 84040 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $3K | $0 | $3K | 59.36% |
| VERONICA TICE4 | 2505 SPRINGBROOK DR LAS VEGAS, NV 89134 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $74 | $0 | $74 | 1.61% |
| CHRISTOPHER R KLEMS4 | 14 E WASHINGTON ST 2ND FLOOR ORLANDO, FL 32801 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $15 | $0 | $15 | 0.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD EIN 84-1017384 ADMIN | Claims processing Service code 12 | — | $102K |
| SHEA INSURANCE, LLC BROKER | Insurance agents and brokers Service code 22 | 5510 S FORT APACHE RD LAS VEGAS, NV 89148 | $69K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $28K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $10K |
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 | 180 | 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) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 162 | $120K |
| Vision | ANTHEM LIFE INSURANCE COMPANY | 222 | $72K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 222 | $72K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 222 | $72K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 222 | $72K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 181 | $270K |
| Other(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 222 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 222 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.