Form 5500 · Employee benefit plan · TUCSON, AZ
SRCV, LLC
The filing calls this plan SRCV, LLC WELFARE BENEFIT PLAN.
SRCV, LLC of TUCSON, AZ files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is CREST INSURANCE GROUP, LLC. Coverage is written through BLUE CROSS BLUE SHIELD OF ARIZONA and 1 other carrier. The plan's most recent policy period ended in February.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 37-1439221 · plan 505 · plan year 2025, filed Sep 22, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
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 health, dental, vision and life; the largest, with BLUE CROSS BLUE SHIELD OF ARIZONA, covers 91 people.
Reported premium across the insured contracts is $675,379, with $51,178 in disclosed broker commissions — about 7.6% of premium.
The most recent policy period ended in February, and the plan year ends March 1. Group contracts typically renew on that annual cycle.
CREST INSURANCE GROUP, LLC is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Two carriers split the book: BLUE CROSS BLUE SHIELD OF ARIZONA and THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ARIZONA | Health | 91 | Mar 1, 2025 | $603,479 | $39,539 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life | 93 | Mar 1, 2025 | $71,900 | $11,639 |
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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