| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA INC | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | — | $3K | 5.83% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 4.06% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 6.38% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 4.22% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $700 | $700 | 2.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 6.45% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 4.28% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $499 | $499 | 2.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $841 | — | $841 | 5.99% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $705 | — | $705 | 5.02% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $281 | $281 | 2.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 12.82% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $677 | — | $677 | 7.19% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $690 | — | $690 | 12.91% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $379 | — | $379 | 7.09% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $81 | — | $81 | 6.43% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $54 | — | $54 | 4.29% |
| PAYCOM PAYROLL LLC3 Filed as: PAYCOM PAYROLL HOLDINGS LLC | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $25 | $25 | 1.98% |
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 | 139 | 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) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 78 | $53K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 78 | $53K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 191 | $35K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $25K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $14K |
| Other(3 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.