| 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 | $154K | $55K | $209K | 16.93% |
| 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 | $14K | — | $14K | 11.92% |
| PAULINE F. RODRIGUEZ3 | 2660 HIGHWAY 231 SOUTH SHELBYVILLE, TN 371606651 | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | $5K | — | $5K | 9.28% |
| 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 | 6.69% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 30 WATERSIDE DR. FARMINGTON, CT 06032 | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | $150 | — | $150 | 0.29% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | 12404 PARK CENTRAL DR. SUITE 400S DALLAS, TX 752511800 | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | $10 | — | $10 | 0.02% |
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 | 247 | 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) | 247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $1.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $1.2M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $1.2M |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 257 | $168K |
| Short-term disability | MANHATTAN LIFE ASSURANCE COMPANY OF AMERICA | 14 | $51K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 257 | $117K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $1.2M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 257 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.