| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INS OFFICE OF AMERICA INC3 | 4915 W CYPRESS STREET TAMPA, FL 33607 | DELTA DENTAL OF VIRGINIA | $798 | — | $798 | 0.43% |
| INSURANCE OFFICE OF AMERICA3 | 4915 W CYPRESS STREET SUITE 100 TAMPA, FL 33607 | UNUM LIFE INSURANCE COMPANY | -$514 | -$39 | -$553 | -0.75% |
| INSURANCE OFFICE OF AMERICA3 | 4915 W CYPRESS ST SUITE 100 TAMPA, FL 33607 | UNUM LIFE INSURANCE COMPANY | -$404 | -$30 | -$434 | -1.06% |
| INSURANCE OFFICE OF AMERICA3 | NATIONAL HEADQUARTERS ALTAMONTE SPRINGS, FL 32716 | EYEMED VISION CARE | $2K | — | $2K | 7.83% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: SEITLIN, MARSH & MCLENNAN | 9850 NW 41ST STREET SUITE 100 MIAMI, FL 33178 | EYEMED VISION CARE | $407 | — | $407 | 1.28% |
| INSURANCE OFFICE OF AMERICA3 | 4915 W CYPRESS ST SUITE 100 TAMPA, FL 33607 | UNUM LIFE INSURANCE COMPANY | -$223 | -$17 | -$240 | -0.87% |
| MARSH & MCLENNAN AGENCY LLC Filed as: MARSH & MCLENNAN | — | BERKLEY LIFE AND HEALTH INSURANCE CO | $2K | — | $2K | 10.00% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A SCOTT & SON | PO BOX 603438 CHARLOTTE, NC 28260 | UNUM LIFE INSURANCE COMPANY | $158 | — | $158 | 2.22% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A SCOTT & SON | PO BOX 603438 CHARLOTTE, NC 28260 | PROVIDENT LAIFE AND ACCIDENT INSURANCE COMPANY | $78 | — | $78 | 1.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA LIFE AND HEALTH INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATOR | Float revenue; Named fiduciary; Claims processing; Contract Administrator; Direct payment from the plan; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $183K |
| ALLEGIANCE BENEFIT PLAN MANAGEMENT EIN 71-0916514 ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $43K |
| CIGNA | Participant communication; Other services; Claims processing; Contract Administrator; Float revenue; Investment advisory (participants); Non-monetary compensation; Named fiduciary; Direct payment from the plan Service code 12 | — | $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 | 591 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 592 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF VIRGINIA | 536 | $187K |
| Vision | EYEMED VISION CARE | 358 | $32K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY | 817 | $115K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY | 127 | $28K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 817 | $74K |
| Stop-loss / reinsurancereinsurance | CIGNA LIFE AND HEALTH INSURANCE COMPANY | 527 | $416K |
| Other(6 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY | 817 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 817 | — |
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.