| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL AVENUE FLOOR 9 PHOENIX, AZ 850121979 | DELTA DENTAL OF ARIZONA | $8K | — | $8K | 12.46% |
| PAUL HERSHENBERG3 | 2101 E. BROADWAY SUITE 6 TEMPE, AZ 85282 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVENUE FLOOR 9 PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $601 | $2K | 8.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES, INC | 3800 N. CENTRAL AVENUE FLOOR 9 PHOENIX, AZ 850121979 | VISION SERVICE PLAN | $668 | — | $668 | 6.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK, GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVENUE FLOOR 9 PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $896 | $157 | $1K | 11.55% |
| EMPLOYEE BENEFITS INTL AZ INC3 Filed as: EMPLOYEE BENEFITS INTERNATIONAL OF | ARIZONA, INC. 7901 N. 16TH STREET, SUITE 200 PHOENIX, AZ 85020 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $37 | — | $37 | 14.86% |
| EMPLOYEE BENEFITS INTL AZ INC3 Filed as: EMPLOYEE BENEFITS INTERNATIONAL OF | ARIZONA, INC. 7901 N. 16TH STREET, SUITE 200 PHOENIX, AZ 85020 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 7.56% |
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 | 164 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ARIZONA | 104 | $62K |
| Vision | VISION SERVICE PLAN | 96 | $10K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 60 | $27K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 60 | $18K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 60 | $18K |
| Stop-loss / reinsurancereinsurance | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 6 | $119 |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 60 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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.