| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WALLACE WELCH & WILLINGHAM INC3 | 300 FIRST AVENUE SOUTH STE 500 ST. PETERSBURG, FL 33701 | AETNA HEALTH, INC. | $1K | $31K | $33K | 1.18% |
| WALLACE WELCH & WILLINGHAM INC3 | 300 FIRST AVENUE SOUTH STE 500 ST. PETERSBURG, FL 33701 | AETNA LIFE INSURANCE CO. | — | $1K | $1K | 0.05% |
| RANDALL DAVID BRISTOWE3 | 11234 SAN JOSE BLVD STE 7 JACKSONVILLE, FL 32223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.04% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $896 | — | $896 | 2.59% |
| RICHARD DOUGLAS KLIMA3 | PO BOX 905494 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $198 | — | $198 | 0.57% |
| AON CONSULTING INC3 Filed as: AON CONSULTING - TAMPA | 29840 NETWORK PLACE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $187 | — | $187 | 0.54% |
| HEIDI S WEISHAUPT3 | 1767 LAKEWOOD RANCH BLVD BRADENTON, FL 34211 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $75 | — | $75 | 0.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA BEHAVIORAL HEALTH, LLC PLAN ADMIN | Plan Administrator Service code 14 | 151 FARMINGTON AVE RSAA HARTFORD, CT 06156 | $5K |
| WALLACE WELCH & WILLINGHAM INC BROKER | Other commissions Service code 55 | 200 FIRST AVE S 5TH FLOOR ST PETERSNURG, 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 | 333 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 338 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 718 | $2.4M |
| Dental | AETNA LIFE INSURANCE CO. | 718 | $2.4M |
| Vision | AETNA LIFE INSURANCE CO. | 718 | $2.4M |
| Life insurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 718 | $2.5M |
| Short-term disability | AETNA LIFE INSURANCE CO. | 718 | $2.4M |
| Long-term disability | AETNA LIFE INSURANCE CO. | 718 | $2.4M |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 718 | $2.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 718 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.