| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N. CENTRAL AVE. 9TH FLOOR PHOENIX, AZ 85012 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $81K | $39K | $121K | 13.79% |
| PAULINE F. RODRIGUEZ3 | 2660 HIGHWAY 231 SOUTH SHELBYVILLE, TN 371606651 | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | $3K | — | $3K | 3.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 850121979 | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.56% |
| THE FARMINGTON COMPANY3 Filed as: THE FARMINGTON CO. | P.O. BOX 527 FARMINGTON, CT 060340527 | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | $162 | — | $162 | 0.16% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE | 12404 PARK CENTRAL DR. SUITE 400S DALLAS, TX 752511800 | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | $57 | — | $57 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVE. 9TH FLOOR PHOENIX, AZ 850121979 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 13.23% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN DRISCOLL & COMPANY INC. | 5080 N. 40TH ST. SUITE 400 PHOENIX, AZ 85018 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $449 | — | $449 | 0.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES, INC. | 3800 N. CENTRAL AVENUE 9TH FLOOR PHOENIX, AZ 850121979 | KANAWHA INSURANCE COMPANY | $1K | — | $1K | 9.00% |
| DONALD J FECHTER3 Filed as: DONALD J. FLETCHER | 2425 S. STEARMAN DRIVE SUITE 110 CHANDLER, AZ 852861594 | KANAWHA INSURANCE COMPANY | — | $396 | $396 | 2.60% |
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 | 81 | 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) | 81 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 144 | $874K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 144 | $874K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 144 | $874K |
| Life insurance(3 contracts, 3 carriers) | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | 81 | $201K |
| Short-term disability | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | 15 | $99K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 81 | $87K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 144 | $874K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 81 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 144 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.