| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REBSAMEN INSURANCE INC3 | REGIONS INSURANCE DPT 268 PO BOX 11407 BIRMINGHAM, AL 35246 | AETNA HEALTH, INC. | — | $2K | $2K | 0.33% |
| REBSAMEN INSURANCE INC3 | REGIONS INSURANCE DEPT 268 PO BOX 1 BIRMINGHAM, AL 35246 | AETNA LIFE INSURANCE COMPANY | $11K | $350 | $12K | 3.24% |
| REGIONS INSURANCE INC3 | DEPT #268 - PO BOX 11407 BIRMINGHAM, AL 35246 | NATIONAL GUARDIAN LIFE | $3K | — | $3K | 6.38% |
| REGIONS INSURANCE INC3 | DEPT# 268 - PO BOX 11407 BIRMINGHAM, AL 35246 | NATIONAL GUARDIAN LIFE | $465 | — | $465 | 11.45% |
| RUBY ROBB3 | 3216 THACKERY WAY PLANT CITY, FL 33566 | AFLAC | $818 | $117 | $935 | — |
| TRACEY H BOURDON3 | 4866 MANDOLIN COURT WINTER HAVEN, FL 33884 | AFLAC | $183 | $23 | $206 | — |
| ROGERS BENEFIT GROUP INC3 Filed as: DEBORAH L ROGERS, INC | 11124 FOSTER CARRIAGE RD LITHIA, FL 33547 | AFLAC | $89 | $23 | $112 | — |
| SUSAN C BRIMHALL3 | 155 CYPRESS LANE SUITE 525 OLDSMAR, FL 34677 | AFLAC | $55 | $23 | $78 | — |
| MARK A LINSNER3 Filed as: MARK A. LINSNER | 10175 FORTUNE PKWY UNIT 604 JACKSONVILLE, FL 32256 | AFLAC | $68 | — | $68 | — |
| JESSICA W MCKENZIE3 | 324 ODELL SHOALS RD WALHALLA, SC 29691 | AFLAC | $67 | — | $67 | — |
| ELEANOR M BREZNAY3 | 919 KEITH LANE AUBURNDALE, FL 33823 | AFLAC | $60 | — | $60 | — |
| PRATT & ASSOCIATES INC3 | 3423 ASHLING DRIVE LAKELAND, FL 33803 | AFLAC | $49 | — | $49 | — |
| TERESA M CAMPBELL3 | 210 WT WYATT RD EASLEY, SC 29642 | AFLAC | $45 | — | $45 | — |
| URSULA HUNT3 | 5707 45TH ST E LOT 208 BRADENTON, FL 34203 | AFLAC | $24 | — | $24 | — |
| DONALD P KREDENSOR3 | 1112 RIVER WALK DR SIMPSONVILLE, SC 29681 | AFLAC | $23 | — | $23 | — |
| AMY L ENOS3 | PO BOX 82451 BATON ROUGE, LA 70884 | AFLAC | $18 | — | $18 | — |
| BARTLEIN AND ASSOC INC3 | 5577 BROADCAST COURT SARASOTA, FL 34240 | AFLAC | $14 | — | $14 | — |
| JAN HAMBY ALDAMUY3 | 16203 MUIRFIELD DR ODESSA, FL 33556 | AFLAC | $13 | — | $13 | — |
| JOHN D TYLER3 | 130 DUCK HAWK WAY MARIETTA, SC 29661 | AFLAC | $12 | — | $12 | — |
| HEARTLAND BENEFITS INC3 | 233 EAST CENTER AVE SEBRING, FL 33870 | AFLAC | $11 | — | $11 | — |
| HARRY E HUNT JR3 | 5707 45TH ST E LOT 208 BRADENTON, FL 34203 | AFLAC | $9 | — | $9 | — |
| JENNIFER HOLLAND3 | 3122 W NORTH ST TAMPA, FL 33614 | AFLAC | $9 | — | $9 | — |
| JOEL M LUSTGARTEN3 | 1695 STARLING DR SARASOTA, FL 34231 | AFLAC | $8 | — | $8 | — |
| JACK RICE INSURANCE LLC3 Filed as: JACK RICE INSURANCE, LLC | 13080 S BELCHER RD STE H LARGO, FL 33773 | AFLAC | $8 | — | $8 | — |
| GARY L RICKETTS INC3 | PO BOX 576 SEFFNER, FL 33583 | AFLAC | $8 | — | $8 | — |
| JOHN J GRUND3 | 4119 24TH AVE WEST BRADENTON, FL 34205 | AFLAC | $7 | — | $7 | — |
| M SCOTT ENOS3 | PO BOX 82451 BATON ROUGE, LA 70884 | AFLAC | $7 | — | $7 | — |
| HUMBERT ALDAMUY JR3 | 16203 MUIRFIELD DR ODESSA, FL 33556 | AFLAC | $6 | — | $6 | — |
| GRAVES INC3 | 5336 CAPTAINS CT NEW PORT RICHEY, FL 34652 | AFLAC | $4 | — | $4 | — |
| AARON ABRAMS COX3 | 38036 MAPLE RIDGE DR PRAIRIEVILLE, LA 70769 | AFLAC | $4 | — | $4 | — |
| J W GRIMES INC3 | 7659 HERITAGE CROSSING WAY REUNION, FL 34747 | AFLAC | $4 | — | $4 | — |
| GROUP PLANS INC3 | PO BOX 5164 LAKELAND, FL 33807 | AFLAC | $3 | — | $3 | — |
| POPPELL INSURANCE, INC.3 Filed as: POPPELL INS INC | 503 W MARTIN LUTHER KING JR BLVD PLANT CITY, SC 33563 | AFLAC | $2 | — | $2 | — |
| DANIEL S ADAMS3 | 3857 SCOTT CHURCH RD MARIANNA, FL 32448 | AFLAC | $2 | — | $2 | — |
| GERALD DECHEN3 | 1643 PINE PLACE CLEARWATER, FL 33755 | AFLAC | $2 | — | $2 | — |
| ELIZABETH B DAY3 | 8617 FORT HUNT RD ALEXANDRIA, VA 22308 | AFLAC | $1 | — | $1 | — |
| ROCKY B CUNNINGHAM JR3 Filed as: ROCKY B CUNNINGHAM, JR | PO BOX 84478 BATON ROUGE, LA 70884 | AFLAC | $1 | — | $1 | — |
| KEITH WILLIAM BELLE3 | 113 FLAGG PLACE BLDGE 6 STEC LAFAYETTE, LA 70508 | AFLAC | $1 | — | $1 | — |
| GLENN L DAYTON3 | 6900 ULMERTON RD 34 LARGO, FL 33771 | AFLAC | $1 | — | $1 | — |
| THOMAS A HOUSE3 | 14055 46TH ST N STE 1104 CLEARWATER, FL 33629 | AFLAC | $1 | — | $1 | — |
| MARIA C ORTIZ3 | 7400 SW 50TH TER STE 300 MIAMI, FL 33155 | AFLAC | $1 | — | $1 | — |
| KELLOGG SMITH & CO.3 Filed as: KELLOGG SMITH & COMPANY | 9499 NE 2ND AVE #204 MIAMI SHORES, FL 33138 | AFLAC | $0 | — | $0 | — |
| MARTA M SASTRE3 | PO BOX 140127 CORAL GABLES, FL 33114 | AFLAC | $0 | — | $0 | — |
| BRANDON C ADAMS3 | 321 SOUTHLAKE DR SAINT AUGUSTINE, FL 32092 | AFLAC | $0 | — | $0 | — |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: JAMES GRAYDON BROWN | 2522 OWENS LANDING TRL NW KENNESAW, GA 30152 | AFLAC | $0 | — | $0 | — |
| ASSURANCE AGENCY LTD3 Filed as: ALLEY REHBAUM & CAPES ASSURANCE INC | PO BOX 4620 CLEARWATER, FL 33758 | AFLAC | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REBSAMEN INSURANCE INC EIN 71-0621654 BROKER | Insurance agents and brokers Service code 22 | REGIONS INSURANCE DEPT 268 PO BOX 11407 BIRMINGHAM, AL 35246 | $49K |
| TEABERRY HEALTH & WELFARE BENEFITS EIN 26-3803402 BROKER | Insurance agents and brokers Service code 22 | 1 PROGRESS PLAZA ST PETERSBURG, FL 33701 | $0 |
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 | 117 | 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) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 117 | $362K |
| Dental | NATIONAL GUARDIAN LIFE | 81 | $41K |
| Vision | NATIONAL GUARDIAN LIFE | 92 | $4K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 117 | $362K |
| Short-term disability(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 117 | $362K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 117 | $362K |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 117 | $362K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 117 | — |
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.