| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | BLUECROSS BLUESHIELD OF ARIZONA | $51K | — | $51K | 7.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE FLOOR 9 PHOENIX, AZ 85012 | DELTA DENTAL OF ARIZONA | $11K | — | $11K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $558 | $4K | 8.38% |
| PAUL HERSHENBERG3 | 2131 E BROADWAY RD STE 29 TEMPE, AZ 85282 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 7.42% |
| BRAD M WHITE3 | 10823 W LOUISE DR SUN CITY, AZ 85373 | AFLAC | $3K | $125 | $3K | 11.24% |
| HERSHENBERG & STONE-WALSH INSURANCE3 | 2131 BROADWAY RD STE 29 TEMPE, AZ 85282 | AFLAC | $2K | — | $2K | 8.37% |
| ANNA KIRBY BALDWIN3 | 615 BRASELTON LN MYRTLE BEACH, SC 29588 | AFLAC | $615 | $3 | $618 | 2.47% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT D ALLEN | 11632 W TENAZA DR PEORIA, AZ 85383 | AFLAC | $251 | — | $251 | 1.00% |
| LANCE D THORSON3 | 1721 12TH AVE NE WATERTOWN, SD 57201 | AFLAC | $159 | $26 | $185 | 0.74% |
| TOM LEE KOCH3 | 24004 N 24TH PL PHOENIX, AZ 85024 | AFLAC | $179 | — | $179 | 0.72% |
| ALFREDO N VARGAS3 | 6230 N FLORENCE AVE LITCHFIELD PARK, AZ 85340 | AFLAC | $146 | — | $146 | 0.58% |
| DAVID R LATTIMER3 | 6605 N 93RD AVE GLENDALE, AZ 85305 | AFLAC | $79 | — | $79 | 0.32% |
| MELISSA A SCHOFIELD3 | 5552 W NORTHWOOD DR GLENDALE, AZ 85310 | AFLAC | $48 | — | $48 | 0.19% |
| CHELSEY PEITZ3 | 31113 N NORTH VALLEY PKWY APT 3036 PHOENIX, AZ 85085 | AFLAC | $44 | — | $44 | 0.18% |
| AUBRIE MICHELLE LANE3 | 1867 N 208TH AVE BUCKEYE, AZ 85396 | AFLAC | $38 | — | $38 | 0.15% |
| ALEXANDRA JACOBI3 | PO BOX 72105 PHOENIX, AZ 85050 | AFLAC | $18 | — | $18 | 0.07% |
| HEAVEN DAWN NORTH3 | 631 W MAIN ST TIPP CITY, OH 45371 | AFLAC | $14 | — | $14 | 0.06% |
| MARK MARQUEZ3 Filed as: MARK A MARQUEZ | 8601 N BLACK CANYON HWY STE 209 PHOENIX, AZ 85021 | AFLAC | $7 | — | $7 | 0.03% |
| ABEL BARSEGYAN3 | 6713 S SENECA WAY GILBERT, AZ 85298 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE 9TH FLOOR PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $258 | $2K | 11.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | AVESIS INSURANCE INCORPORATED | $1K | — | $1K | 13.38% |
| HERSHENBERG & STONE-WALSH INSURANCE3 Filed as: HERSHENBERG & STONE-WALSH INS | 2131 E BROADWAY RD SUITE 29 TEMPE, AZ 85282 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 13.03% |
| BERNIERI PAUL3 | 154 HAMPTON RD GARDEN CITY, NY 11417 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $471 | — | $471 | 5.25% |
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 | 240 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 240 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ARIZONA | 107 | $720K |
| Dental | DELTA DENTAL OF ARIZONA | 180 | $71K |
| Vision | AVESIS INSURANCE INCORPORATED | 141 | $10K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 240 | $70K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 240 | $45K |
| Prescription drug | BLUECROSS BLUESHIELD OF ARIZONA | 107 | $720K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 240 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 240 | — |
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.