| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PASSEY BOND CO INC3 Filed as: PASSEY BOND CO., INC. | PO BOX 819 MESA, AZ 85211 | BLUE CROSS BLUE SHIELD | $21K | — | $21K | 3.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD | 3800 N CENTRAL FL9 PHOENIX, AZ 85012 | DELTA DENTAL OF AZ | $7K | — | $7K | 10.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD | 3800 N CENTRAL FL9 PHOENIX, AZ 85012 | UNITED OF OMAHA LIFE INS | $1K | — | $1K | 3.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD | 3800 N CENTRAL FL9 PHOENIX, AZ 85012 | UNITED OF OMAHA LIFE INS | $2K | — | $2K | 13.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD | 3800 N CENTRAL FL9 PHOENIX, AZ 85012 | UNITED OF OMAHA LIFE INSURANCE | $2K | — | $2K | 9.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD | 3800 N CENTRAL FL9 PHOENIX, AZ 85012 | VISION SERVICE PLAN | $349 | — | $349 | 3.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD | 3800 N CENTRAL FL9 PHOENIX, AZ 85012 | UNITED OF OMAHA LIFE INS | $342 | — | $342 | 9.99% |
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 | 186 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD | 186 | $627K |
| Dental | DELTA DENTAL OF AZ | 181 | $69K |
| Vision | VISION SERVICE PLAN | 139 | $9K |
| Life insurance | UNITED OF OMAHA LIFE INS | 86 | $18K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE | 112 | $16K |
| Long-term disability | UNITED OF OMAHA LIFE INS | 81 | $38K |
| Prescription drug | BLUE CROSS BLUE SHIELD | 186 | $627K |
| Other | UNITED OF OMAHA LIFE INS | 208 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 208 | — |
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."
No prospect flags tripped on this filing.