| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS ALLEN GIBSON3 Filed as: THOMAS GIBSON | 16837 SOUTH 18TH WAY PHOENIX, AZ 85048 | BLUE CROSS AND BLUE SHIELD OF ARIZONA | $52K | $0 | $52K | 11.16% |
| T GIBSON BENEFITS CONSULTING LLC3 | 16837 SOUTH 18TH WAY PHOENIX, AZ 85048 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $0 | $0 | 0.00% |
| 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 | $226K |
| EVICORE EIN 47-2500642 MEDICAL CONSULTING | Claims processing Service code 12 | 400 BUCKWALTER PLACE BLVD BLUFFTON, SC 29910 | $5K |
| AMERICAN SPECIALTY HEALTH SYSTEMS EIN 33-0938349 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | 10221 WATERIDGE CIRCLE #2702 SAN DIEGO, CA 92121 | $3K |
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 | 380 | 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) | 380 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF ARIZONA | 313 | $462K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 380 | $341K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF ARIZONA | 380 | $803K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 380 | $341K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 380 | $341K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 380 | $341K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF ARIZONA | 313 | $462K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 380 | $341K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 380 | — |
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.