| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAURIE NICOLARY3 | 14021 E HUPPENTHAL BLVD. VAIL, AZ 85641 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $25K | — | $25K | 11.00% |
| INTEGRITY ADMINISTRATORS, INC.5 | 1787 TRIBUTE ROAD, STE E SACRAMENTO, CA 95815 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $9K | — | $9K | 3.88% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 731250360 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | — | $3K | 4.52% |
| CENTRAL AUTOMOTIVE UNDERWRITERS OF3 Filed as: CENTRAL AUTOMOTIVE UNDERWRITERS | PO BOX 7320 RENO, NV 89510 | AMERICAN FIDELITY ASSURANCE COMPANY | $3K | — | $3K | 4.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INTEGRITY ADMINISTRATORS, INC. EIN 68-0394770 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 1787 TRIBUTE ROAD, SUITE E SACRAMENTO, CA 95815 | $41K |
| NEVADA PREFERRED HEALTHCARE EIN 80-0442103 PPO | Claims processing Service code 12 | PROVIDERS 1625 E. PRATER WAY STE. C-102 SPARKS, NV 89434 | $5K |
| HINES & ASSOCIATES, INC. EIN 36-3545085 LARGE CASE MA NAGEMENT O | Other services Service code 49 | 14 NORTH FIRST AVENUE, SUITE 1403 ST. CHARLES, IL 60174 | $3K |
| DIVERSIFIED DENTAL SERVICES, INC. EIN 88-0346054 DENTAL PREFER RED PROVID | Claims processing Service code 12 | 4720 N. ORADE ROAD, STE 100 TUSCON, AZ 85705 | $857 |
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 114 | $225K |
| Dental | FIDELITY SECURITY LIFE INSURANCE COMPANY | 114 | $225K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 114 | $225K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 114 | $71K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 114 | $71K |
| Prescription drug | FIDELITY SECURITY LIFE INSURANCE COMPANY | 114 | $225K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 114 | $225K |
| Other | AMERICAN FIDELITY ASSURANCE COMPANY | 114 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 114 | — |
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.