| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BCBS OF ARIZONA | BCBS OF AIRZONA PHOENIX, AZ 85021 | EQUITABLE | — | $228 | $228 | 5.41% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN BROWN OF WASHINGTON | 701 5 TH AVENUE STE 550 SEATTLE, WA 98104 | EQUITABLE | — | $61 | $61 | 1.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BROWN AND BROWN OF WA EIN 91-0378940 NONE | Consulting (general); Direct payment from the plan; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 16 | — | $75K |
| VIMLY BENEFIT SOLUTIONS EIN 91-1603312 NONE | Contract Administrator; Plan Administrator; Direct payment from the plan Service code 13 | — | $18K |
| MEDICAL SOCIETY HEALTHCARE TRUST NONE | Other services; Direct payment from the plan Service code 49 | 2401 W PEORIA AVE STE 315 PHOENIX, AZ 85029 | $15K |
| HORIZON BENEFITS GROUP NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | 6245 N 24TH ST PHOENIX, AZ 85016 | $9K |
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 | 254 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 224 | $953K |
| Dental | BLUE CROSS BLUE SHIELD OF ARIZONA | 224 | $953K |
| Vision | VISION SERVICE PLAN | 21 | $2K |
| Life insurance | EQUITABLE | 75 | $4K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 224 | $953K |
| Other | EQUITABLE | 75 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 224 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.