| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHEA INSURANCE LLC3 | 5510 S FORT APACHE RD LAS VEGAS, NV 89148 | ANTHEM LIFE INSURANCE COMPANY | $18K | $0 | $18K | 26.53% |
| D'ANN DABELL4 | 1174 N 2000 E LAYTON, UT 84040 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | $0 | $1K | 18.39% |
| BRANDON R SAMANIEGO4 | 31860 RUTH LN HOMELAND, CA 92548 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $228 | $0 | $228 | 4.14% |
| JP PROSPERITY PARTNERS LLC3 | 11536 W PRISTINEBROOK DR STAR, ID 83669 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $220 | $0 | $220 | 3.99% |
| VERONICA TICE4 | 2505 SPRINGBROOK DR LAS VEGAS, NV 89134 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $64 | $0 | $64 | 1.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD EIN 84-1017384 ADMIN | Claims processing Service code 12 | — | $89K |
| SHEA INSURANCE, LLC BROKER | Insurance agents and brokers Service code 22 | 5510 S FORT APACHE RD LAS VEGAS, NV 89148 | $73K |
| THE BENECON GROUP,LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $31K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $11K |
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 | 222 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 157 | $145K |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 157 | $145K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 222 | $68K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 222 | $68K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 222 | $68K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 187 | $296K |
| Other(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 222 | $74K |
| 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."
No prospect flags tripped on this filing.