| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVE., FLOOR 9 PHOENIX, AZ 850121979 | UNITED HEALTHCARE INSURANCE COMPANY | $6K | — | $6K | 2.87% |
| M & O AGENCIES INC3 Filed as: M & O AGENCIES, INC. | 1835 S. EXTENSION ROAD MESA, AZ 852105942 | UNITED HEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 0.83% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 5110 N. 40TH STREET, SUITE 234 PHOENIX, AZ 85018 | UNITED HEALTHCARE INSURANCE COMPANY | $1K | — | $1K | 0.57% |
| M & O AGENCIES INC3 Filed as: M&O AGENCIES DBS MAHONEY GROUP | 1835 S. EXTENSION ROAD MESA, AZ 85210 | COMPANION LIFE INSURANCE | $9K | — | $9K | 12.61% |
| GERALD G. HARTMAN3 | 1487 SOUTH DAVID LANE BOISE, ID 83705 | COMPANION LIFE INSURANCE | $2K | — | $2K | 2.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVE., 9TH FLOOR PHOENIX, AL 85012 | AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS | $4K | — | $4K | 10.28% |
| AMCHECK NATIONAL BROKER SERV. CORP.3 Filed as: AMCHECK | 5030 E. SUNRISE PHOENIX, AZ 85044 | ARIZONA EYECARE ALLIANCE | $1K | — | $1K | 10.00% |
| WINSTON FINANCIAL SERVICES3 Filed as: WINSTON FINANCIAL SERVICES, INC. | 2399 HWY 34 SOUTH, UNIT C2 MANASQUAN, NJ 08736 | TRANSAMERICA | $5K | — | $5K | 57.58% |
| AMCHECK NATIONAL BROKER SERV. CORP.3 | 5030 E. SUNRISE DR. PHOENIX, AZ 85044 | TRANSAMERICA | $2K | — | $2K | 22.01% |
| PARAGON PARTNERS LTD3 Filed as: PARAGON PARTNERS LIMITED | 9420 E. DOUBLETREE RANCH ROAD SUITE C103 SCOTTSDALE, AZ 85258 | TRANSAMERICA | $235 | — | $235 | 2.67% |
| RAYMOND HEBERT3 | 13882 E. LAUREL LANE SCOTTSDALE, AZ 85259 | AFLAC | $222 | — | $222 | 6.09% |
| PETER LEMIEUX AGENCY, INC.3 | 3751 S. VELERO STREET CHANDLER, AZ 85286 | AFLAC | $58 | — | $58 | 1.59% |
| SHAWN HOLTORF3 | 5522 W. NORTHWOOD DRIVE GLENDALE, AZ 85310 | AFLAC | $53 | — | $53 | 1.45% |
| SCOTT WEBB3 | 2155 W. PINNACLE PEAK ROAD SUITE 205 PHOENIX, AZ 85027 | AFLAC | $22 | — | $22 | 0.60% |
| MARTIN ANTHO MAVIS3 | 3910 S ALDER DRIVE TEMPE, AZ 85282 | AFLAC | $18 | — | $18 | 0.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $33K |
| M & O AGENCIES DBS MAHONEY GROUP EIN 86-6050329 BROKER | Insurance agents and brokers Service code 22 | — | $15K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $9K |
| GERALD G. HARTMAN BROKER | Insurance agents and brokers Service code 22 | 1487 SOUTH DAVID LANE BOISE, ID 83705 | $6K |
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 | 136 | 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) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 69 | $214K |
| Dental | AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS | 93 | $42K |
| Vision | ARIZONA EYECARE ALLIANCE | 116 | $12K |
| Life insurance | TRANSAMERICA | 21 | $9K |
| Short-term disability(2 contracts, 2 carriers) | TRANSAMERICA | 21 | $12K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE | 90 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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.