| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PASSEY BOND CO INC3 Filed as: PASSEY-BOND CO., INC. | 28 N CENTER ST MESA, AZ 85201 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $62K | $0 | $62K | 14.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL 9TH FL PHOENIX, AZ 85012 | COMPANION LIFE INS CO | $7K | $0 | $7K | 6.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK-GOULD & ASSOCIATES, INC. | 3800 N CENTRAL FL 9 PHOENIX, AZ 85012 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.19% |
| PASSEY BOND CO INC3 Filed as: PASSEY-BOND CO., INC. | 28 N CENTER ST MESA, AZ 85201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL FL 9 PHOENIX, AZ 85012 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $337 | $337 | 5.01% |
| PASSEY BOND CO INC3 Filed as: PASSEY-BOND CO., INC | 28 N CENTER ST MESA, AZ 85201 | UNUM LIFE INSURANCE COMPANY | $671 | $0 | $671 | 15.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS EIN 59-1031071 ADMIN SERVICE AGMT | Named fiduciary; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Participant communication Service code 12 | — | $218K |
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 | 406 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 406 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | COMPANION LIFE INS CO | 365 | $102K |
| Vision | VISION SERVICE PLAN | 166 | $23K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 228 | $7K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 406 | $413K |
| Other | UNUM LIFE INSURANCE COMPANY | 79 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 406 | — |
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.