| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD AND ASSOCIATES INC. | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | BLUE CROSS BLUE SHIELD OF ARIZONA | $33K | $138 | $34K | 5.01% |
| 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 | 6.97% |
| 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 | $4K | $294 | $4K | 19.86% |
| CSA GENERAL INSURANCE AGENCY3 Filed as: CSA GENERAL INSURANCE AGENCY, INC. | 2480 WEST LAS PALMARITA DRIVE PHOENIX, AZ 85021 | AVESIS INSURANCE INCORPORATED | $1K | $0 | $1K | 10.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD AND ASSOCIATES | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | AVESIS INSURANCE INCORPORATED | $439 | $0 | $439 | 3.88% |
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 | 99 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 98 | $670K |
| Dental | AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS | 93 | $31K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 114 | $682K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 99 | $19K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 99 | $19K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 98 | $670K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 99 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 114 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.