| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASHLEY A D'SOUZA3 Filed as: ASHLEY ANDREW D SOUZA | 1880 VALLEY ROAD BLOOMFIELD, MI 48304 | UNITED HEALTHCARE INSURANCE COMPANY | $5K | $4K | $8K | 10.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVENUE, 9TH FL PHOENIX, AZ 85012 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVENUE, 9TH FL PHOENIX, AZ 85012 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $922 | — | $922 | 10.00% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 119 | $75K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 119 | $75K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 107 | $14K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 107 | $9K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 107 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 119 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.