| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| H LARAINE OLIPHANT3 | 3580 W. INA ROAD SUITE 150 TUCSON, AZ 85741 | BCBSAZ | $49K | $0 | $49K | 4.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATION INC | 3800 N CENTRAL AVE FLOOR 9 PHOENIX, AZ 850121979 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $16 | $14K | 10.89% |
| H LARAINE OLIPHANT3 | 3580 W. INA ROAD SUITE 150 TUCSON, AZ 85741 | AFLAC | $2K | $111 | $2K | 11.87% |
| KEVIN DALE HARLOW3 | 2960 N. ACADEMY BLVD STE 101 COLORADO SPRINGS, CO 80917 | AFLAC | $380 | $19 | $399 | 2.13% |
| ZACHARY ALLEN HARLOW3 | 2960 N. ACADEMY BLVD STE 101 COLORADO SPRINGS, CO 80917 | AFLAC | $174 | $15 | $189 | 1.01% |
| DAVID R LATTIMER3 | 3029 N SONORAN HILLS MESA, AZ 85207 | AFLAC | $136 | $0 | $136 | 0.73% |
| JEFFERY KENT DELLINGER3 | 603 JEFFERSON DAVIS HWY STE 201 FREDERICKSBURG, VA 22401 | AFLAC | $56 | $10 | $66 | 0.35% |
| SANDRA L SARFF3 | 7090 ORACLE ROAD PMB 152 TUCSON, AZ 85704 | AFLAC | $55 | $0 | $55 | 0.29% |
| CATHERINE DAVIS3 Filed as: CATHERINE B DAVIS | 9160 E LOMA LINDA PL TUCSON, AZ 85749 | AFLAC | $55 | $0 | $55 | 0.29% |
| ERIC PEDERSON3 | 2615 N. 4TH STREET STE 1 FLAGSTAFF, AZ 86004 | AFLAC | $37 | $0 | $37 | 0.20% |
| DONALD GREEN3 Filed as: DONALD A GREEN | 1611 W. PLACITA GARBO GREEN VALLEY, AZ 85622 | AFLAC | $28 | $0 | $28 | 0.15% |
| MARK HILL3 | PO BOX 85715 TUCSON, AZ 85754 | AFLAC | $24 | $0 | $24 | 0.13% |
| SCOTT WEBB3 | 12366 W MILTON DR PEORIA, AZ 85383 | AFLAC | $23 | $0 | $23 | 0.12% |
| JACK GATHINGS3 | 7235 S. GOLFSIDE LANE PHOENIX, AZ 85042 | AFLAC | $14 | $0 | $14 | 0.07% |
| JEFFERY F HOKE3 | 517 E. 3270 N LEHI, UT 84043 | AFLAC | $14 | $0 | $14 | 0.07% |
| CHAD P SCHIIEDER3 | 360 W HUBBARD ST APT 1105 CHICAGO, IL 60654 | AFLAC | $8 | $0 | $8 | 0.04% |
| SHARON MCKELVEY3 Filed as: SHARON I MCKELVEY | 197 N. NOTTINGHAM LANE LOT3 PAYSON, AZ 85541 | AFLAC | $6 | $0 | $6 | 0.03% |
| NATALIE MALHAM3 | 3850 E. BASELINE ROAD STE 168 MESA, AZ 85206 | AFLAC | $3 | $0 | $3 | 0.02% |
| MICHAEL G GLADNICK3 | 3850 E BASELINE RS STE 116 MESA, AZ 85206 | AFLAC | $3 | $0 | $3 | 0.02% |
| JEFFERY KLEINMAN SR3 Filed as: JEFFERY A KLEINMAN SR | 3420 SHEA BLVD STE 168 PHOENIX, AZ 85028 | AFLAC | $2 | $0 | $2 | 0.01% |
| MICHAEL G RYAN3 | 836 HOOSIER PASS PRESCOTT, AZ 86301 | AFLAC | $1 | $0 | $1 | 0.01% |
| JEFFERY S GIBSON3 | 4805 LAKE BROOK DR STE 220 GLEN ALLEN, VA 23060 | AFLAC | $1 | $0 | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 NORTH CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 85012 | PRINCIPAL (EMPLOYERS DENTAL SERVICES) | $1K | $0 | $1K | 9.60% |
| CREST INSURANCE GROUP LLC3 Filed as: CREST INSURANCE GROUO LLC | 5285 E. WILLIAMS CIRCLE STE 4500 TUCSON, AZ 85711 | PRINCIPAL (EMPLOYERS DENTAL SERVICES) | $110 | $0 | $110 | 0.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 NORTH CENTRAL AVE, 9TH FLOOR PHOENIX, AZ 85012 | AVESIS | $1K | $0 | $1K | 11.71% |
| CREST INSURANCE GROUP LLC3 Filed as: CREST INSURANCE GROUP, LLC | 2321 NORTH 4TH STREET FLAGSTAFF, AZ 86004 | AVESIS | $114 | $0 | $114 | 0.99% |
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 | 123 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSAZ | 129 | $978K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $144K |
| Vision | AVESIS | 121 | $12K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $133K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $133K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $133K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 361 | — |
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.