| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD AND ASSOCIATES | 3800 NORTH CENTRAL AVENUE PHOENIX, AZ 85012 | BLUE CROSS BLUE SHIELD OF ARIZONA | $30K | $0 | $30K | 4.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD AND ASSOCIATES, INC. | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS | $2K | $0 | $2K | 7.25% |
| SUSAN MULLIGAN3 | 8118 SOUTH MANN AVENUE TUCSON, AZ 85710 | AFLAC | $3K | $57 | $3K | 10.23% |
| MJ INSURANCE3 Filed as: PATTY NATIONS AND VARIOUS AGENTS | 7850 NORTH SILVERBELL ROAD SUITE 114-130 TUCSON, AZ 85743 | AFLAC | $614 | $23 | $637 | 2.23% |
| KIMBERELY RODRIGUEZ3 | 37057 SOUTH GAMBEL QUAIL DRIVE MARANA, AZ 85658 | AFLAC | $496 | $0 | $496 | 1.74% |
| SETH G KNOWLTON3 Filed as: SETH KNOWLTON | PO BOX 68766 TUCSON, AZ 85737 | AFLAC | $371 | $0 | $371 | 1.30% |
| SANDRA L SARFF3 Filed as: SANDRA SARFF | 7090 NORTH ORACLE ROAD, PMB 152 TUCSON, AZ 85710 | AFLAC | $157 | $0 | $157 | 0.55% |
| LEAVITT GROUP3 Filed as: KOTY LEAVIT INSURANCE AGENCY, INC. | 6992 EAST BROADWAY BOULEVARD TUCSON, AZ 85710 | AFLAC | $157 | $0 | $157 | 0.55% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $117 | $0 | $117 | 0.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD AND ASSOCIATES INC. | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $181 | $3K | 21.25% |
| CSA GENERAL INSURANCE AGENCY3 Filed as: CSA GENERAL INSURANCE AGENCY, INC. | 2480 WEST LS PALMARITA DRIVE PHOENIX, AZ 85021 | AVESIS INSURANCE INCORPORATED | $2K | $0 | $2K | 16.00% |
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 | 107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 102 | $601K |
| Dental | AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS | 81 | $29K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 118 | $611K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 34 | $14K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 34 | $14K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 102 | $601K |
| Other(2 contracts, 2 carriers) | AFLAC | 34 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 118 | — |
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.