| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287, SUITE 230 CHICAGO, IL 60694 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $141K | $141K | 5.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 200 SOUTH ORANGE AVENUE SUITE 1350 ORLANDO, FL 32801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $19K | $0 | $19K | 11.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 736 SOUTH STONE AVENUE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $9K | $9K | 5.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $12K | — | $12K | 9.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $457 | $4K | 9.50% |
| WORKSITE BENEFITS SOLUTION LLC3 Filed as: WORKSITE BENEFITS SOLUTIONS, LLC | 2622 WYMAN CIRCLE KISSIMMEE, FL 34744 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $1K | $2K | 5.99% |
| CALVON Y. BUCZKOWSKI & OTHER AGENTS3 | 204 COVERED BRIDGE DRIVE OCOEE, FL 34761 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $279 | $1K | 3.29% |
| COLLETTE G BOISVERT3 Filed as: COLLETTE G. BOISVERT | 349 CENTRAL STREET MANCHESTER, NH 03103 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $6 | $1K | 2.91% |
| SARAH WEYMOUTH3 Filed as: SARAH WEYMOUTH, LLC | 107 OCEAN TER INDIALANTIC, FL 32903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $614 | $209 | $823 | 2.05% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 WEST STATE ROAD 434 LONGWOOD, FL 32750 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $410 | $0 | $410 | 1.02% |
| MICHAEL G BOYCE3 Filed as: MICHAEL G. BOYCE | 518 TENNESSEE AVENUE SAINT CLOUD, FL 34769 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $290 | $5 | $295 | 0.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $841 | $106 | $947 | 5.71% |
| WORKSITE BENEFITS SOLUTION LLC3 Filed as: WORKSITE BENEFITS SOLUTIONS, LLC | 2622 WYMAN CIRCLE KISSIMMEE, FL 34744 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $462 | $366 | $828 | 4.99% |
| JENNIFER WEYMOUTH RESMONDO3 Filed as: JENNIFER WEYMOUTH, LLC & OTHERS | 2940 OAKTREE DRIVE KISSIMMEE, LA 34744 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $518 | $20 | $538 | 3.24% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 WEST STATE ROAD 434 LONGWOOD, FL 32750 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $409 | $0 | $409 | 2.47% |
| SARAH WEYMOUTH3 Filed as: SARAH WEYMOUTH, LLC | 107 OCEAN TERRACE INDIALANTIC, FL 32903 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $259 | $51 | $310 | 1.87% |
| CALVON Y BUCZKOWSKI3 Filed as: CALVON Y. BUCZKOWSKI | 204 COVERED BRIDGE DRIVE OCOEE, FL 34761 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $99 | $47 | $146 | 0.88% |
| COLLETTE G BOISVERT3 Filed as: COLLETTE G. BOISVERT | 349 CENTRAL STREET MANCHESTER, NH 03103 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
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 | 387 | 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) | 387 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 229 | $2.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 199 | $126K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 199 | $126K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 387 | $168K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 387 | $168K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 387 | $168K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 229 | $2.5M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 387 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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.