| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 85012 | DELTA DENTAL OF ARIZONA | $8K | $0 | $8K | 11.47% |
| HERSHENBERG & STONE-WALSH INSURANCE3 Filed as: HERSHENBERG, PAUL | 2131 E BROADWAY RD SUITE 29 TEMPE, AZ 85282 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 9.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 5.46% |
| HERSHENBERG & STONE-WALSH INSURANCE3 | 2131 E BROADWAY RD SUITE 29 TEMPE, AZ 85258 | AFLAC | $1K | $0 | $1K | 6.29% |
| BRAD M WHITE3 | 10823 W LOUISE DR SUN CITY, AZ 85373 | AFLAC | $999 | $10 | $1K | 5.55% |
| ALFREDO N VARGAS3 | 6230 N FLORENCE AVE LITCHFIELD PARK, AZ 85340 | AFLAC | $280 | $2 | $282 | 1.55% |
| DAVID R LATTIMER3 | 6605 N 93RD AVE GLENDALE, AZ 85305 | AFLAC | $216 | $2 | $218 | 1.20% |
| MELISSA A SCHOFIELD3 Filed as: MELISSA SCHOFIELD | 5552 W NORTHWOOD DR GLENDALE, AZ 85310 | AFLAC | $88 | $0 | $88 | 0.48% |
| LANCE D THORSON3 | 1721 12TH AVE NE WATERTOWN, SD 57201 | AFLAC | $65 | $0 | $65 | 0.36% |
| CHELSEY PEITZ3 | 31113 N NORTH VALLEY PKWY APT 3036 PHOENIX, AZ 85085 | AFLAC | $51 | $0 | $51 | 0.28% |
| LANCE D THORSON3 | 6745 N 93RD AVE UNIT 1154 GLENDALE, AZ 85305 | AFLAC | $48 | $0 | $48 | 0.26% |
| ABEL BARSEGYAN INSURANCE SERVICES3 | 314 W LOMITA AVE GLENDALE, CA 91204 | AFLAC | $36 | $0 | $36 | 0.20% |
| HEAVEN DAWN NORTH3 | 631 W MAIN ST TIPP CITY, OH 45371 | AFLAC | $14 | $0 | $14 | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $167 | $2K | 10.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 85012 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | $0 | $1K | 12.98% |
| HERSHENBERG & STONE-WALSH INSURANCE3 | 2131 E BROADWAY RD SUITE 29 TEMPE, AZ 85282 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 16.09% |
| BERNIERI PAUL3 | 13305 CROSS BAY BLVD OZONE PARK, NY 11417 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $522 | $0 | $522 | 6.16% |
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 | 173 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ARIZONA | 173 | $68K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 144 | $10K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 65 | $64K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 65 | $49K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 65 | $31K |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 65 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.