| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | DELTA DENTAL OF ARIZONA | $8K | — | $8K | 12.50% |
| PAUL HERSHENBERG3 | 2101 E. BROADWAY SUITE 6 TEMPE, AZ 85282 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC. | 3800 N CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $319 | $1K | 8.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC. | 3800 N CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $200 | $1K | 11.75% |
| HUB INTERNATIONAL MIDWEST LIMITED5 Filed as: BLACK, GOULD & ASSOCIATES | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 12.98% |
| HERSHENBERG & STONE-WALSH INSURANCE3 | SERVICES LLC 2101 E BROADWAY ROAD, SUITE 30 TEMPE, AZ 85282 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 21.66% |
| PAUL BERNIERI3 | 13305 CROSS BAY BOULEVARD OZONE PARK, NY 11417 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $164 | — | $164 | 3.37% |
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 | 178 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ARIZONA | 119 | $60K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 183 | $11K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 61 | $16K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 61 | $16K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 61 | $16K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 61 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 183 | — |
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.