| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOC., INC. | 3800 N. CENTRAL AVE., 9TH FL PHOENIX, AZ 85012 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $697 | $2K | 12.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES | 4516 E. CAMP LOWELL DRIVE TUCSON, AZ 85712 | AVESIS INSURANCE INCORPORATED | $2K | — | $2K | 13.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOC., INC. | 3800 N. CENTRAL AVE., 9TH FL PHOENIX, AZ 85012 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $929 | $3K | 21.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOC., INC. | 3800 N. CENTRAL AVE., 9TH FL PHOENIX, AZ 85012 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $683 | $2K | 15.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOC., INC. | 3800 N. CENTRAL AVE., 9TH FL PHOENIX, AZ 85012 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $637 | $2K | 15.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOC., INC. | 3800 N. CENTRAL AVE., 9TH FL PHOENIX, AZ 85012 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $590 | $2K | 21.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLACK GOULD & ASSOCIATES BROKER | Direct payment from the plan; Insurance agents and brokers; Other commissions Service code 22 | 4516 E. CAMP LOWELL DR. TUCSON, AZ 85712 | $40K |
| CIGNA HEALTH AND LIFE INS CO EIN 59-1031071 CLAIMS ADMINISTRATOR | Contract Administrator Service code 13 | — | $33K |
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 | 196 | 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) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 39 | $20K |
| Vision | AVESIS INSURANCE INCORPORATED | 196 | $18K |
| Life insurance(2 contracts) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 131 | $30K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 25 | $10K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 126 | $13K |
| Other(2 contracts) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 131 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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.