Form 5500 · Employee benefit plan · TEMPE, AZ
EMPACT - SUICIDE PREVENTION CENTER
The filing calls this plan EMPACT-SPC WELFARE/MEDICAL PLAN.
Public Form 5500 records show how EMPACT - SUICIDE PREVENTION CENTER of TEMPE, AZ, a health care and social assistance employer, structures its employee benefits. Its broker of record is CBIZ BENEFITS AND INS SERVICES INC. Coverage is written through EMPLOYERS DENTAL SERVICES and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 74-2562293 · plan 501 · plan year 2025, filed Jul 30, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 2 insured contracts covering dental and vision; the largest, with EMPLOYERS DENTAL SERVICES, covers 266 people.
Reported premium across the insured contracts is $50,980, with $2,739 in disclosed broker commissions — about 5.4% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
CBIZ BENEFITS AND INS SERVICES INC is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Two carriers split the book: EMPLOYERS DENTAL SERVICES and VISION SERVICE PLAN.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| EMPLOYERS DENTAL SERVICES | Dental | 266 | Jan 1, 2026 | $34,235 | $2,739 |
| VISION SERVICE PLAN | Vision | 158 | Jan 1, 2026 | $16,745 | $0 |
Premium and claims on this contract
VISION SERVICE PLAN, contract 30028231. For the contract year on this filing, the carrier reported $16,745 in premium earned and $11,013 in claims incurred. Dividing one by the other gives 66%.
- VISION SERVICE PLAN, contract 30028231 reported $2,847 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
How this plan compares
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