| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | BLUE CROSS BLUE SHIELD OF ARIZONA | $33K | — | $33K | 4.44% |
| WESTERN GROWERS INSURANCE SERVICES3 Filed as: WESTERN GROWERS INSURANCE | 17620 FITCH STREET IRVINE, CA 92614 | BLUE CROSS BLUE SHIELD OF ARIZONA | $12K | — | $12K | 1.62% |
| JAMES D THRESHER3 | 1316 E NIGHTINGALE LANE GILBERT, AZ 85298 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $7K | $16K | 18.75% |
| GLORIA GUERRA3 | 34212 N 23RD GLEN PHOENIX, AZ 85085 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $3K | $9K | 10.74% |
| RITA MARIE SCHAEFER3 | 5415 NORTH 179TH DRIVE LITCHFIELD PARK, AZ 85340 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 5.64% |
| DENISE KOTULA3 | 9825 N. 70TH ST. SCOTTSDALE, AZ 85253 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $1K | $3K | 3.02% |
| OMAR LEON3 | 3124 N 21ST STREET PHOENIX, AZ 85016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 1.65% |
| JEFFREY THOMAS3 | PO BOX 11312 TEMPE, AZ 85284 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $269 | $12 | $281 | 0.33% |
| DEBORAH ANN BERRY3 | 1042 E 9TH PLACE MESA, AZ 85203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $213 | $2 | $215 | 0.25% |
| SUSAN HENDRICKS3 | 6718 N PALM CANYON DR PHOENIX, AZ 85018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $3 | $17 | 0.02% |
| GENTRY INSURANCE INC3 | 9140 W COOLBROOK AVE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $1 | $15 | 0.02% |
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 | 155 | 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) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 155 | $735K |
| Vision | BLUE CROSS BLUE SHIELD OF ARIZONA | 155 | $735K |
| Life insurance | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 84 | $86K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 84 | $86K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 155 | $735K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 155 | — |
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.