| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVE. 9TH FLOOR PHOENIX, AZ 850121979 | HUMANA INSURANCE COMPANY | $30K | — | $30K | 9.47% |
| DONALD J FECHTER3 Filed as: DONALD J. FECHTER | 2450 S. GILBERT ROAD SUITE 109 CHANDLER, AZ 852861594 | HUMANA INSURANCE COMPANY | — | $3K | $3K | 0.93% |
| PAULINE F. RODRIGUEZ3 | 6600 S. GRANITE DRIVE CHANDLER, AZ 852498993 | KANAWHA INSURANCE COMPANY | $7K | — | $7K | 7.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 850121979 | KANAWHA INSURANCE COMPANY | $7K | — | $7K | 6.76% |
| THE FARMINGTON COMPANY3 Filed as: THE FARMINGTON CO. | P.O. BOX 527 FARMINGTON, CT 060340527 | KANAWHA INSURANCE COMPANY | $4K | $253 | $4K | 3.98% |
| DONALD J FECHTER3 Filed as: DONALD J. FECHTER | 2450 S. GILBERT ROAD SUITE 109 CHANDLER, AZ 852861594 | KANAWHA INSURANCE COMPANY | — | $242 | $242 | 0.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVE. 9TH FLOOR PHOENIX, AZ 85012 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $589 | $5K | 17.89% |
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 | 196 | 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) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HUMANA INSURANCE COMPANY | 194 | $318K |
| Vision | HUMANA INSURANCE COMPANY | 194 | $318K |
| Life insurance | HUMANA INSURANCE COMPANY | 194 | $318K |
| Short-term disability | KANAWHA INSURANCE COMPANY | 28 | $96K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 57 | $30K |
| Other(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 194 | $414K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.