| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FISHER BROWN BOTTRELL INSURANCE | 248 EAST CAPITOL STREET SUITE 1200 JACKSON, MS 39201 | HCC LIFE INSURANCE COMPANY | $55K | — | $55K | 12.50% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FISHER BROWN BOTTRELL INSURANCE | PO BOX 1490 JACKSON, MS 39215 | STARMOUNT LIFE INSURANCE COMPANY | $11K | — | $11K | 10.40% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FISHER BROWN BOTTRELL INSURANCE | 500 GRAND BOULEVARD SUITE 220 MIRAMAR BEACH, FL 32550 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $1K | $8K | 17.50% |
| JOEL T. ALLEN4 | 544 PAWNEE WAY MADISON, WI 39110 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 14.03% |
| TIM C. LEWIS4 | 218 VALLEY RIDGE DRIVE JACKSON, MS 39206 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $294 | — | $294 | 2.20% |
| SHIRLEY ALLEN4 | 141 N. MAPLE STREET RIDGELAND, MS 39157 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $174 | — | $174 | 1.30% |
| BROOKS WERKHEISER4 | PO BOX 447 PONTE VERDRA BEACH, FL 32004 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $102 | — | $102 | 0.76% |
| KAREN M. MCDOWELL4 | 405 YUPON AVENUE FAIRHOPE, AL 36532 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $59 | — | $59 | 0.44% |
| KEITH E. SMITH4 | 834 BLISSFIELD CHATTANOOGA, TN 37419 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $43 | — | $43 | 0.32% |
| STUART P. BURGESS4 | 144 HUNTERS ROW MADISON, MS 39110 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $38 | — | $38 | 0.28% |
| TERESA M. BURGESS4 | 144 HUNTERS ROW MADISON, MS 39110 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $13 | — | $13 | 0.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FOX EVERETT A DIVSION OF HUB INTERN EIN 35-0672425 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $59K |
| BOTTRELL EIN 64-0887176 BROKER | Custodial (securities) Service code 19 | — | $13K |
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 | 318 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 25 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 345 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 214 | $102K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 214 | $102K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 318 | $43K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 318 | $43K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 266 | $443K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 318 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 318 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.