| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA3 | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | BLUE CROSS BLUE SHIELD OF FLORIDA | $20K | $0 | $20K | 4.93% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | BLUE CROSS BLUE SHIELD OF FLORIDA | $10K | $0 | $10K | 3.91% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 7.86% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $588 | $0 | $588 | 2.14% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 11.12% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $523 | $0 | $523 | 3.88% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $834 | $0 | $834 | 11.33% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $271 | $0 | $271 | 3.68% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $832 | $0 | $832 | 11.37% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $265 | $0 | $265 | 3.62% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $818 | $0 | $818 | 12.08% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $198 | $0 | $198 | 2.92% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $518 | $0 | $518 | 7.74% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $151 | $0 | $151 | 2.26% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $518 | $0 | $518 | 11.08% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $183 | $0 | $183 | 3.91% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC | 2056 VISTA PKWY STE 350 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $181 | $0 | $181 | 11.02% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 2056 VISTA PKWY STE 305 WEST PALM BEACH, FL 33411 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $65 | $0 | $65 | 3.96% |
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 | 122 | 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) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS BLUE SHIELD OF FLORIDA | 66 | $651K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 55 | $27K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 59 | $7K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $8K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $13K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $5K |
| Prescription drug(2 contracts) | BLUE CROSS BLUE SHIELD OF FLORIDA | 66 | $651K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.