| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF FLORIDA, LLC | 3705 W SWANN AVE FL 2 TAMPA, FL 33609 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $58K | $22K | $80K | 18.44% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF FLORIDA, LLC | 4880 NEWBERRY RD STE 180 GAINESVILLE, FL 32607 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 2.17% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $8K | $8K | 1.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 MEDICAL PLAN ADMIN | Claims processing; Direct payment from the plan; Float revenue; Other services; Non-monetary compensation; Named fiduciary; Contract Administrator; Participant communication Service code 12 | — | $369K |
| FLORES AND ASSOCIATES EIN 56-1542307 FSA/COBRA/HSA FEES | Claims processing; Contract Administrator Service code 12 | — | $19K |
| RELYMD EIN 84-4856129 PLAN ADMINISTRATION | Contract Administrator; Claims processing Service code 12 | — | $14K |
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 | 420 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 431 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HUMANA INSURANCE COMPANY | 368 | $21K |
| Vision | EYEMED VISION CARE | 319 | $41K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 420 | $432K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 420 | $432K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 420 | $432K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 423 | $447K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 423 | — |
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.