| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1715 NORTH WEST SHORE BOULEVARD SUITE 700 TAMPA, FL 33607 | BLUE CROSS BLUE SHIELD OF FLORIDA | $45K | $0 | $45K | 3.60% |
| USI INSURANCE SERVICES LLC3 | 1715 NORTH WEST SHORE BOULEVARD SUITE 700 TAMPA, FL 33607 | HEALTH OPTIONS | $5K | $0 | $5K | 2.38% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $18K | $0 | $18K | 10.37% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $5K | $5K | 2.98% |
| SHIRLEY B DRAKE3 Filed as: SHIRLEY B. DRAKE | 14141 46TH STREET NORTH, SUITE 1209 CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $265 | $0 | $265 | 3.03% |
| DANA BRETT POLK3 | 10801 STARKEY ROAD, SUITE 104-321 SEMINOLE, FL 33777 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | $0 | $111 | 1.27% |
| WORKSITE AMERICA LLC3 Filed as: WORKSITE AMERICA, LLC | 14141 46TH STREET NORTH, SUITE 1209 CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | $15 | $97 | 1.11% |
| SHELBY GROUP INC3 Filed as: SHELBY GROUP, INC. | 3496 EAST WOODMONT WAY PALM HARBOR, FL 34684 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | $0 | $95 | 1.09% |
| JOHN R. PAPA AND OTHER AGENTS3 | 4750 STONEVIEW CIRCLE OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $0 | $58 | 0.66% |
| WALTER H MODARELLI3 Filed as: WALTER H. MODARELLI | 265 GROVEFIELD DRIVE FORT MILL, SC 29715 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | $0 | $37 | 0.42% |
| PATRICIA M CARDUCCI3 Filed as: PATRICIA M. CARDUCCI | 4784 SIMCOE STREET PALM HARBOR, FL 34683 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | $0 | $36 | 0.41% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $857 | $0 | $857 | 12.00% |
| ALLSTATE BENEFITS3 | 1776 AMERICAN HERITAGE LIFE DRIVE JACKSONVILLE, FL 32224 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $571 | $0 | $571 | 7.99% |
| KELLEY J RHEAULT4 Filed as: KELLEY J. RHEAULT | 155 CONCHA DRIVE SEBASTIAN, FL 32958 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $269 | $0 | $269 | 10.85% |
| USI INSURANCE SERVICES LLC4 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $97 | $0 | $97 | 3.91% |
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 | 99 | 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) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF FLORIDA | 70 | $1.5M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $176K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $176K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $185K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $176K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $176K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF FLORIDA | 70 | $1.5M |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 99 | $188K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.