| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS ALLEN GIBSON3 Filed as: THOMAS GIBSON | 16837 S 18TH WAY PHOENIX, AZ 85048 | BLUE CROSS BLUE SHIELD OF ARIZONA | $33K | $997 | $34K | 7.32% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVS INC | 700 W 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | BLUE CROSS BLUE SHIELD OF ARIZONA | $17K | — | $17K | 3.57% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 951 YAMATOROAD, SUITE 200W BOCA RATON, FL 33431 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 0.31% |
| THOMAS ALLEN GIBSON3 | 16837 S 18TH WAY PHOENIX, AZ 85048 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $596 | — | $596 | 0.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ARIZONA EIN 86-0004538 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | 8220 NORTH 23RD AVENUE PHOENIX, AZ 85021 | $210K |
| AMERICAN SPECIALTY HEALTH SYSTEMS EIN 33-0938349 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $5K |
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 | 368 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 307 | $462K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 368 | $327K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 368 | $790K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 368 | $327K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 368 | $327K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 368 | $327K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 307 | $462K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 368 | $327K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 368 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.