| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | AETNA LIFE INSURANCE | $50K | — | $50K | 4.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 6.21% |
| CSA GENERAL INSURANCE AGENCY3 | 2480 W LAS PALMARITAS DR PHOENIX, AZ 85021 | USABLE LIFE | $15K | — | $15K | 25.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | DELTA DENTAL PLAN OF ARIZONA | $4K | — | $4K | 7.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | AETNA LIFE INSURANCE (SRC) | $3K | — | $3K | 10.24% |
| CSA GENERAL INSURANCE AGENCY3 | 2480 W LAS PALMARITAS DR PHOENIX, AZ 85021 | USABLE LIFE | $5K | — | $5K | 25.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | AVESIS INSURANCE INCORPORATED | $2K | — | $2K | 12.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | EMPLOYERS DENTAL SERVICES | $751 | — | $751 | 8.87% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AND FINANCIAL SERVI | 4851 LYNDON B JOHNSON FWY STE 1100 DALLAS, TX 752446025 | METROPOLITAN LIFE INSURANCE COMPANY | $230 | $146 | $376 | 4.90% |
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 | 264 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE | 264 | $1.3M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL PLAN OF ARIZONA | 96 | $63K |
| Vision | AVESIS INSURANCE INCORPORATED | 162 | $14K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 231 | $73K |
| Short-term disability | USABLE LIFE | 101 | $58K |
| Long-term disability(2 contracts, 2 carriers) | USABLE LIFE | 102 | $26K |
| Prescription drug | AETNA LIFE INSURANCE | 264 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.