| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CORPORATE BENEFIT SOLUTIONS3 Filed as: CORPORATE BENEFIT SOLUTIONS, LLC | 7668 E MILTON DR SCOTTSDALE, AZ 85266 | BLUE CROSS BLUE SHIELD OF ARIZONA | — | $250 | $250 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N CENTRAL AVE, 8TH FLOOR PHOENIX, AZ 85012 | BLUE CROSS BLUE SHIELD OF ARIZONA | — | $150 | $150 | 0.02% |
| CONNEXION INSURANCE SOLUTIONS3 Filed as: CONNEXION INSURANCE SOLUTIONS, INC. | P.O. BOX 34315 M/S 320 SEATTLE, WA 981241315 | METROPOLITAN LIFE INSURANCE COMPANY | $408 | — | $408 | 4.19% |
| CONNEXION INSURANCE SOLUTIONS3 Filed as: CONNEXION INSURANCE SOLUTIONS, INC. | P.O. BOX 34315 M/S 320 SEATTLE, WA 981241315 | METROPOLITAN LIFE INSURANCE COMPANY | $28 | — | $28 | 0.41% |
| CONNEXION INSURANCE SOLUTIONS3 Filed as: CONNEXION INSURANCE SOLUTIONS, INC. | P.O. BOX 34315 M/S 320 SEATTLE, WA 981241315 | METROPOLITAN LIFE INSURANCE COMPANY | $247 | — | $247 | 4.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLACK GOULD & ASSOCIATES NONE | Insurance agents and brokers; Direct payment from the plan; Insurance brokerage commissions and fees Service code 22 | 3800 N CENTRAL AVE, 9TH FLOOR PHOENIX, AZ 85012 | $37K |
| HR BENEFITS, INC. EIN 81-3527701 NONE | Finders' fees / placement fees; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Other fees; Insurance brokerage commissions and fees; Consulting fees; Insurance agents and brokers; Insurance services; Consulting (general) Service code 15 | — | $22K |
| BROWN & BROWN OF WA, INC. DBA DIMAR EIN 91-0378940 NONE | Insurance agents and brokers; Consulting fees; Direct payment from the plan; Insurance services; Consulting (general); Finders' fees / placement fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance brokerage commissions and fees Service code 15 | — | $19K |
| VIMLY BENEFIT SOLUTIONS, INC. EIN 91-1603312 NONE | Recordkeeping fees; Contract Administrator; Other commissions; Copying and duplicating; Participant communication; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing) Service code 10 | — | $12K |
| ARIZONA TECHNOLOGY COUNCIL EIN 86-0684848 SPONSOR | Finders' fees / placement fees; Other services; Participant communication; Other fees; Direct payment from the plan Service code 38 | — | $7K |
| CORPORATE BENEFIT SOLUTIONS, LLC EIN 27-5435615 NONE | Insurance brokerage commissions and fees; Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $7K |
| PIONEER EMPLOYEE BENEFITS EIN 84-2248426 NONE | Insurance agents and brokers; Direct payment from the plan; Insurance brokerage commissions and fees Service code 22 | — | $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 | 187 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 187 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 124 | $756K |
| Dental | BLUE CROSS BLUE SHIELD OF ARIZONA | 124 | $756K |
| Vision | VISION SERVICE PLAN | 81 | $6K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 127 | $7K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 60 | $6K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 60 | $10K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 124 | $756K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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.
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.