| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYEE BENEFITS INT'L ARIZONA INC3 | 2525 EAST ARIZONA BILTMORE CIRCLE SUITE D1 PHOENIX, AZ 85016 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $86K | $5K | $90K | 15.29% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $14K | $14K | 2.34% |
| EMPLOYEE BENEFITS INTERNATIONAL3 Filed as: EMPLOYEE BENEFITS INTERNATIONAL INC | 8828 NORTH CENTRAL AVENUE SUITE 100 PHOENIX, AZ 85020 | DELTA DENTAL OF ARIZONA | $5K | $0 | $5K | 8.21% |
| EMPLOYEE BENEFITS INTERNATIONAL3 Filed as: EMPLOYEE BENEFITS INTERNATIONAL INC | 7901 NORTH 16TH STREET, SUITE 200 PHOENIX, AZ 85020 | DELTA DENTAL OF ARIZONA | $877 | $0 | $877 | 1.33% |
| GIS BENEFITS INC3 Filed as: GIS NATIONAL | 9500 KROGER AVENUE, SUITE 200 ST PETERSBURG, FL 33702 | METLIFE LEGAL PLANS, INC. | $5K | $0 | $5K | 34.75% |
| EMPLOYEE BENEFITS INT'L ARIZONA INC3 | 2525 EAST ARIZONA BILTMORE CIRCLE SUITE D1 PHOENIX, AZ 85020 | METLIFE LEGAL PLANS, INC. | $2K | $0 | $2K | 15.87% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 | PO BOX 9201, SUITE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS, INC. | $0 | $1K | $1K | 8.06% |
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 | 1,266 | 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. |
| Total participants (= "Plan participants" tile) | 1,266 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | DELTA DENTAL OF ARIZONA | 1,081 | $66K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,245 | $592K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,245 | $592K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,245 | $592K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,245 | $607K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,245 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.