| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 2300 RENAISSANCE BOULEVARD KING OF PRUSSIA, PA 19406 | BLUE CROSS BLUE SHIELD OF ARIZONA | $60K | — | $60K | 5.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 NORTH CENTRAL AVENUE PHOENIX, AZ 85012 | BLUE CROSS BLUE SHIELD OF ARIZONA | $20K | — | $20K | 1.84% |
| LOVITT AND TOUCHE, INC.3 | 161 WASHINGTON STREET, SUITE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $0 | $5K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 NORTH CENTRAL, 9TH FLOOR PHOENIX, AZ 85012 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $3K | $3K | 5.00% |
| THE NIA GROUP3 | 161 WASHINGTON STREET, SUITE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $756 | $756 | 1.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 NORTH CENTRAL, 9TH FLOOR PHOENIX, AZ 85012 | DELTA DENTAL OF ARIZONA, INC. | $3K | $0 | $3K | 7.04% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | DELTA DENTAL OF ARIZONA, INC. | $3K | — | $3K | 6.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES | 3800 NORTH CENTRAL, 9TH FLOOR PHOENIX, AZ 85012 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $572 | — | $572 | 4.62% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | PO BOX 350 CONSHOHOCKEN, PA 19428 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | $389 | $2K | 19.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $275 | $275 | 2.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $87 | $87 | 0.94% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 2300 RENAISSANCE BOULEVARD KING OF PRUSSIA, PA 19406 | ALPHA DENTAL OF ARIZONA, INC | $531 | $0 | $531 | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 NORTH CENTRAL, 9TH FLOOR PHOENIX, AZ 85012 | ALPHA DENTAL OF ARIZONA, INC | $133 | $0 | $133 | 2.50% |
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 | 135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 176 | $1.1M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF ARIZONA, INC. | 163 | $54K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 143 | $12K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 135 | $54K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 135 | $54K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ARIZONA | 176 | $1.1M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 135 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 176 | — |
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.