| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| H LARAINE OLIPHANT | 3580 W INA ROAD SUITE 150 TUCSON, AZ 85741 | BLUE CROSS BLUE SHIELD OF ARIZONA | $45K | $0 | $45K | 4.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 850121979 | METROPOLITAN LIFE INSURANCE COMPANY | $13K | $2K | $15K | 12.89% |
| H LARAINE OLIPHANT | 3580 W INA ROAD SUITE 150 TUCSON, AZ 85741 | AFLAC | $6K | $310 | $6K | 16.05% |
| KEVIN DALE HARLOW | 6281 N ORACLE RD UNIT 35072 TUCSON, AZ 85740 | AFLAC | $1K | $62 | $1K | 3.20% |
| ZAKERY ALLEN HARLOW | 3755 N BUSINESS CENTER DR TUCSON, AZ 85705 | AFLAC | $708 | $62 | $770 | 2.00% |
| SANDRA L SARFF | 7090 N ORACLE ROAD 178 PMB 152 TUCSON, AZ 85704 | AFLAC | $189 | — | $189 | 0.49% |
| CATHERINE DAVIS Filed as: CATHERINE B DAVIS | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $141 | — | $141 | 0.37% |
| ERIC PEDERSON | 1600 W UNIVERSITY AVE SUITE 104 FLAGSTAFF, AZ 86001 | AFLAC | $132 | — | $132 | 0.34% |
| SCOTT WEBB | 2155 W PINNACLE PEAK RD SUITE 205 PHOENIX, AZ 85027 | AFLAC | $109 | $20 | $129 | 0.34% |
| DONALD GREEN Filed as: DONALD A GREEN | 1611 W PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $71 | — | $71 | 0.18% |
| MARK HILL | 7673 N SUMMIT PASS PRESCOTT VALLEY, AZ 86315 | AFLAC | $65 | — | $65 | 0.17% |
| JACK GATHINGS | 7235 S GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $65 | — | $65 | 0.17% |
| JERRY DUNCAN Filed as: JERRY F HOKE | 517 E 3270 N LEHI, UT 84043 | AFLAC | $56 | — | $56 | 0.15% |
| MARK HILL | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $46 | — | $46 | 0.12% |
| ERIC PEDERSON | 2615 N 4TH ST SUITE 1 FLAGSTAFF, AZ 86004 | AFLAC | $46 | — | $46 | 0.12% |
| ZAKERY ALLEN HARLOW | 3204 N ACADEMY BLVD SUITE 130 COLORADO SPRINGS, CO 80917 | AFLAC | $37 | — | $37 | 0.10% |
| KEVIN DALE HARLOW | 3204 N ACADEMY BLVD SUITE 130 COLORADO SPRINGS, CO 80917 | AFLAC | $34 | — | $34 | 0.09% |
| CHAD P SCHNEIDER | 14430 BENEFIT ST APT 308 SHERMAN OAKS, CA 91423 | AFLAC | $5 | — | $5 | 0.01% |
| SHARON MCKELVEY Filed as: SHARON I MCKELVEY | 197 N NOTTINGHAM LANE LOT 3 PAYSON, AZ 85541 | AFLAC | $3 | — | $3 | 0.01% |
| JEFFREY A KLEINMAN SR | 3420 E SHEA BLVD SUITE 168 PHOENIX, AZ 85028 | AFLAC | $2 | — | $2 | 0.01% |
| NATALIE MALHAM | 3850 E BASELINE ROAD SUITE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.01% |
| MICHAEL G GLADNICK | 3850 E BASELINE ROAD SUITE 116 MESA, AZ 85206 | AFLAC | $2 | — | $2 | 0.01% |
| TIMOTHY MARTIN Filed as: TIMOTHY I MARTIN | 20516 N 80TH LANE PEORIA, AZ 85382 | AFLAC | $1 | — | $1 | 0.00% |
| LAUREL L HARLOW | 3755 N BUSINESS CENTRE DR SUITE 4 TUCSON, AZ 85705 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL G RYAN | 836 HOOSIRE PASS PRESCOTT, AZ 86301 | AFLAC | $1 | — | $1 | 0.00% |
| JEFFERY S GIBSON | 4805 LAKE BROOK DRIVE SUITE 220 GLEN ALLEN, VA 23060 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BLACK GOULD & ASSOCIATES | 4516 E CAMP LOWELL DRIVE TUCSON, AZ 85712 | EMPLOYERS DENTAL SERVICES | $1K | — | $1K | 10.89% |
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 | 115 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ARIZONA | 115 | $912K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 343 | $130K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 343 | $118K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 343 | $118K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 343 | $118K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 343 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 343 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.