| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R K MATHEWS INC3 | 853 GREENS AVE ORLANDO, FL 32804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $347 | $1 | $348 | 2.57% |
| KAREN PICCININI3 | 425 W COLONIAL DR ORLANDO, FL 32804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $147 | — | $147 | 1.09% |
| JOHN PICCININI3 | 425 W COLONIAL DR ORLANDO, FL 32804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $74 | $1 | $75 | 0.55% |
| STEVEN VERMETTE INC3 | 920 SPRING PARK LOOP CELEBRATION, FL 34747 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.32% |
| NANCY BENNETT & ASSOCIATES INC3 | SJO 84626 MIAMI, FL 33126 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| WILLIAM RENNARD3 | 3001 ALOMA AVE WINTER PARK, FL 32792 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $127 | — | $127 | 1.80% |
| LOUIS R FAIOLA3 Filed as: LOUIS J PANTALONE | PO BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $55 | — | $55 | 0.78% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF FLORIDA INC | 29848 NETWORK PL CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.23% |
| R K MATHEWS INC3 | 853 GREENS AVE ORLANDO, FL 32804 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.10% |
| R K MATHEWS INC3 | 853 GREENS AVE ORLANDO, FL 32804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $218 | $7 | $225 | 3.27% |
| KAREN PICCININI3 | 425 W COLONIAL DR ORLANDO, FL 32804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | $6 | $92 | 1.34% |
| JOHN PICCININI3 | 425 W COLONIAL DR ORLANDO, FL 32804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | $8 | $54 | 0.79% |
| STEVEN VERMETTE INC3 | 920 SPRING PARK LOOP CELEBRATION, FL 34747 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.15% |
| DONNA N DWYER3 | 1540 WESTBROOK PLAZA DRIVE WINSTON SALEM, NC 27103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $4 | $8 | 0.12% |
| PENELOPE DEAN KENNY3 | 3555 S OCEAN BLVD S PALM BEACH, FL 33480 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.06% |
| PHIL COLEMAN3 | 18908 RIVERWIND LN DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.06% |
| SHIRLEY B DRAKE3 | 14141 46TH STREET N CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.04% |
| MARK F BARRETT LLC3 | 14141 46TH STREET N CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $130K |
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 | 294 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 294 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(4 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 651 | $119K |
| Short-term disability(4 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 651 | $119K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 651 | $91K |
| Other(4 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 651 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 651 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.