| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 2502 NORTH ROCKY POINT DRIVE SUITE 400 TAMPA, FL 33607 | UNITEDHEALTHCARE INSURANCE COMPANY | $1K | $10K | $11K | 5.46% |
| SHIRLEY B DRAKE3 Filed as: SHIRLEY B. DRAKE | 14141 46TH STREET NORTH, SUITE 1209 CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $20 | $6K | 7.18% |
| MJ INSURANCE3 Filed as: CHAMBERS AGENCY AND VARIOUS AGENTS | 304 WOODBRIDGE WAY SIMPSONVILLE, SC 29681 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $483 | $4K | 5.32% |
| SHELBY GROUP INC3 Filed as: SHELBY GROUP, INC. | 3496 EAST WOODMONT WAY PALM HARBOR, FL 34684 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 4.85% |
| WORKSITE BENEFITS SOLUTION LLC3 Filed as: WORKSITE AMERICA, LLC | 14141 46TH STREET NORTH, SUITE 1209 CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $669 | $2K | 2.70% |
| DANA BRETT POLK3 | 10801 STARKEY ROAD, SUITE 104-321 SEMINOLE, FL 33777 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.58% |
| PATRICIA M CARDUCCI3 Filed as: PATRICIA M. CARDUCCI | 4784 SIMCOE STREET PALM HARBOR, FL 34683 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.54% |
| STEVEN P MOORE3 Filed as: STEVEN P. MOORE | 500 BEAR DRIVE GREENVILLE, SC 29605 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $792 | $0 | $792 | 1.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 15.00% |
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 | 208 | 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) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 232 | $208K |
| Dental(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 232 | $208K |
| Vision(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 232 | $208K |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 208 | $103K |
| Short-term disability(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 208 | $26K |
| Prescription drug(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 232 | $208K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 208 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 232 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.