| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | SELECTHEALTH | $54K | — | $54K | 3.99% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 225 3900 E CAMELBACK ROAD PHOENIX, AZ 85018 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $68K | $8K | $75K | 7.47% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS CORROON CORP. OF AZ | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | DELTA DENTAL OF ARIZONA | $27K | — | $27K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12K | $2K | $14K | 7.51% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18K | — | $18K | 10.24% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | SUITE 225 3900 E CAMELBACK ROAD PHOENIX, AZ 85018 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.64% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 225 3900 E CAMELBACK ROAD PHOENIX, AZ 85018 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $674 | $10K | 10.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 10.52% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | SUITE 225 3900 E CAMELBACK ROAD PHOENIX, AZ 85018 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 2.27% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 100 9225 PRIORITY WAY WEST DRIVE INDIANAPOLIS, IN 46240 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $2K | $7K | 12.84% |
| ASSUREX3 | SUITE 800 175 SOUTH 3RD STREET COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $3K | $6K | 10.76% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 225 3900 E CAMELBACK ROAD PHOENIX, AZ 85018 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $79 | $6K | 10.67% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA, INC. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | BLUE CROSS BLUE SHIELD OF ARIZONA | $482 | — | $482 | 1.32% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 100 9225 PRIORITY WAY WEST DRIVE INDIANAPOLIS, IN 46240 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $637 | $2K | 22.69% |
| ASSUREX3 | SUITE 800 175 SOUTH 3RD STREET COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $775 | — | $775 | 8.37% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 225 3900 E CAMELBACK ROAD PHOENIX, AZ 85018 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $518 | — | $518 | 5.60% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | SUITE 225 3900 E CAMELBACK ROAD PHOENIX, AZ 85018 | FIRST UNUM LIFE INSURANCE COMPANY | $11 | $1 | $12 | 7.19% |
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 | 885 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 894 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 7 | $37K |
| Dental | DELTA DENTAL OF ARIZONA | 612 | $549K |
| Vision(2 contracts, 2 carriers) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 772 | $83K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,316 | $1.0M |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 230 | $90K |
| Long-term disability(7 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,316 | $1.5M |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 7 | $37K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,316 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,316 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.