| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MAIN ST EXEC & EMPLOYEE BENEFITS3 | LLC 7440 N ORACLE RD BLDG 5 TUCSON, AZ 85704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | — | $10K | 7.00% |
| ROGERS BENEFIT GROUP INC3 | 12222 MERIT DRIVE #1780 DALLAS, TX 75251 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.50% |
| MAIN ST EXEC & EMPLOYEE BENEFITS3 | LLC 7440 N ORACLE RD BLDG 5 TUCSON, AZ 85704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | — | $13K | 10.00% |
| MAIN ST EXEC & EMPLOYEE BENEFITS3 | LLC 7440 N ORACLE RD BLDG 5 TUCSON, AZ 85704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 17.00% |
| MAIN ST EXEC & EMPLOYEE BENEFITS3 | LLC 7440 N ORACLE RD BLDG 5 TUCSON, AZ 85704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 17.00% |
| CSA GENERAL INSURANCE AGENCY3 | C/O BCBS ATTN CASH CONTROL PHOENIX, AZ 85069 | EYEMED VISION CARE | $2K | — | $2K | 6.10% |
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 | 355 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 355 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 355 | $467K |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 201 | $173K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 425 | $494K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 568 | $87K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 568 | $144K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 568 | $126K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 355 | $467K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF ARIZONA | 355 | $467K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 568 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 568 | — |
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.