| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS. | PO BOX 730054 DALLAS, TX 75373 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $40K | $0 | $40K | 7.37% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 3900 EAST CAMELBACK ROAD, SUITE 225 PHOENIX, AZ 85018 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $19K | $0 | $19K | 3.47% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 16220 NORTH SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $531 | $0 | $531 | 0.47% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS W INC | 16220 NORTH SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, IN 85254 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $916 | $12K | 17.02% |
| BUSINESSOLVER.COM, INC.3 Filed as: BUSINESSOLVER, INC. | PO BOX 310411 DES MOINES, IA 50331 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 5.50% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $2 | $2K | 2.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | PO BOX 730054 DALLAS, TX 75373 | DELTA DENTAL OF ARIZONA | $4K | $0 | $4K | 6.87% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 3900 EAST CAMELBACK ROAD, SUITE 225 PHOENIX, AZ 85018 | DELTA DENTAL OF ARIZONA | $2K | $0 | $2K | 2.61% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS W INC | 16220 NORTH SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $646 | $11K | 19.11% |
| BUSINESSOLVER.COM, INC.3 Filed as: BUSINESSOLVER, INC. | PO BOX 310411 DES MOINES, IA 50331 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 5.50% |
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 | 1,291 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,314 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,935 | $113K |
| Vision | DELTA DENTAL OF ARIZONA | 1,081 | $65K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,291 | $607K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,291 | $548K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,291 | $548K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,291 | $621K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,935 | — |
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.