| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 Filed as: THE SEGAL CO EASTERN STATES IN | 333 W 34TH ST. NEW YORK, NY 10001 | SYMETRA LIFE INSURANCE COMPANY | — | $2K | $2K | 2.37% |
| CSA GENERAL INS AGENCY INC3 Filed as: CSA GENERAL INS AGENCY INC. | 2480 W LAS PALMARITAS DR PHOENIX, AZ 85021 | SYMETRA LIFE INSURANCE COMPANY | — | $2K | $2K | 1.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 ADMIN SERVICES | Non-monetary compensation; Claims processing; Participant communication; Contract Administrator; Named fiduciary; Direct payment from the plan; Other services; Float revenue Service code 12 | — | $879K |
| BENESYS INC NONE OTHER THAN CONTRACT | Contract Administrator Service code 13 | 7180 KOLL CENTER PARKWAY, SUITE 200 PLEASANTON, CA 94566 | $674K |
| THE SEGAL COMPANY EIN 13-1835864 NONE OTHER THAN CONTRACT | Consulting (general) Service code 16 | 1230 WEST WASHINGTON STREET SUITE 501 TEMPE, AZ 85281 | $261K |
| UNITED CLAIMS SOLUTIONS EIN 20-0908354 NONE OTHER THAN CONTRACT | Claims processing Service code 12 | 10835 N 25TH AVE SUITE 105 PHOENIX, AZ 85029 | $260K |
| MERRILL LYNCH EIN 13-3180817 NONE OTHER THAN CONTRACT | Investment advisory (plan) Service code 27 | 2555 E CAMELBACK RD #900 PHOENIX, AZ 85016 | $185K |
| BLUE CROSS BLUE SHIELD OF AZ EIN 86-0004538 NONE OTHER THAN CONTRACT | Other insurance fees and expenses Service code 73 | PO BOX 13466 PHOENIX, AZ 85002 | $149K |
| FRINGE BENEFIT SERVICES, INC EIN 84-0620086 NONE OTHER THAN CONTRACT | Contract Administrator Service code 13 | 7010 NORTH BROADWAY SUITE 106 DENVER, CO 80221 | $122K |
| JENNINGS, STROUSS & SALMON EIN 86-0108229 NONE OTHER THAN CONTRACT | Legal Service code 29 | 201 E WASHINGTON ST 11TH FLOOR PHOENIX, AZ 85004 | $60K |
| WARD KEENAN AND BARRETT, PC EIN 86-0274260 NONE OTHER THAN CONTRACT | Legal Service code 29 | 2141 E CAMELBACK RD STE 100 PHOENIX, AZ 85016 | $56K |
| BALDWIN & BALDWIN PLLC EIN 46-4370753 NONE OTHER THAN CONTRACT | Accounting (including auditing) Service code 10 | 701 NORTH 44TH STREET PHOENIX, AZ 85008 | $48K |
| DELTA DENTAL EIN 86-0274899 NONE OTHER THAN CONTRACT | Claims processing Service code 12 | PO BOX 61595 PHOENIX, AZ 85004 | $48K |
| MCMORGAN & CO EIN 94-1650768 NONE OTHER THAN CONTRACT | Investment management Service code 28 | ONE FRONT STREET SUITE 500 SAN FRANCISCO, CA 94111 | $39K |
| DPN USA, LLC DBA HEALTHFAIR PLUS NONE OTHER THAN CONTRACT | Other services Service code 49 | 1030 SPRING VILLAS POINT SUITE 3000 WINTER SPRINGS, FL 32708 | $34K |
| HEALTHWAVES EIN 86-0554636 NONE OTHER THAN CONTRACT | Other services Service code 49 | 1615 W UNIVERSITY DR SUITE 137 TEMPE, AZ 85281 | $28K |
| WELLS FARGO BANK EIN 41-1592157 NONE OTHER THAN CONTRACT | Custodial (securities) Service code 19 | 100 W WASHINGTON STREET 22ND FLOOR PHOENIX, AZ 85003 | $21K |
| EAP PREFERRED EIN 86-0438189 NONE OTHER THAN CONTRACT | Other services Service code 49 | 99 EAST VIRGINIA AVE SUITE 275 PHOENIX, AZ 85004 | $15K |
| CHUBB EIN 13-1963496 NONE OTHER THAN CONTRACT | Insurance services Service code 23 | 2800 N CENTRAL AVENUE SUITE 1600 PHOENIX, AZ 85004 | $10K |
| CIGNA | Other services; Direct payment from the plan; Contract Administrator; Participant communication; Float revenue; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $0 |
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 | 1,465 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,465 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | EMPLOYERS DENTAL SERVICES | 200 | $26K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 1,423 | $94K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,575 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,575 | — |
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.