| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL FL 9 PHOENIX, AZ 85012 | UNITED HEALTHCARE INSURANCE COMPANY | $48K | $0 | $48K | 10.50% |
| PASSEY BOND CO INC3 Filed as: PASSEY-BOND CO., INC. | 28 N CENTER ST MESA, AZ 85201 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL FL 9 PHOENIX, AZ 85012 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 3.00% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN DRISCOLL & COMPANY INC. | 5080 N 40TH ST #400 PHOENIX, AZ 85018 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | -$9 | $0 | -$9 | -0.02% |
| PASSEY BOND CO INC3 Filed as: PASSEY-BOND CO., INC. | 28 N CENTER ST MESA, AZ 85201 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.95% |
| BRIAN EDWARD JUND3 Filed as: BRIAN JUND | 23282 MILL CREEK DRIVE LAGUNA HILLS, CA 92563 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | $882 | $882 | 5.00% |
| ARIZONA BENEFIT PLANS INC3 Filed as: ARIZONA BENEFIT PLANS | 1850 N CENTRAL SUITE 2000 PHOENIX, AZ 85004 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $714 | $0 | $714 | 4.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL FL 9 PHOENIX, AZ 85012 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | $0 | $1K | 9.72% |
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 | 203 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 203 | $458K |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $48K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 169 | $12K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 180 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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.