| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RANDALL DAVID BRISTOWE3 | 11234 SAN JOSE BLVD. SUITE 7 JACKSONVILLE, FL 32223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 7.46% |
| SHAWN I. STUBBS3 | 11234 SAN JOSE BLVD. SUITE 7 JACKSONVILLE, FL 32223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 5.78% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $819 | $257 | $1K | 2.05% |
| RICHARD DOUGLAS KLIMA3 | PO BOX 905494 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $190 | — | $190 | 0.36% |
| AON CONSULTING INC3 Filed as: AON CONSULTING - TAMPA | 29840 NETWORK PLACE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $161 | — | $161 | 0.31% |
| HEIDI S WEISHAUPT3 Filed as: HEIDI SUSANNE WEISHAUPT | 4520 29TH AVENUE CIRCLE EAST PARRISH, FL 34219 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.06% |
| RANDALL D BRISTOWE3 Filed as: RANDALL D. BRISTOWE | 11234 SAN JOSE BLVD SUITE 7 JACKSONVILLE, FL 32223 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 12.77% |
| SHAWN I. STUBBS3 | 11234 SAN JOSE BLVD SUITE 7 JACKSONVILLE, FL 32223 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 12.77% |
| 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 EIN 59-1203168 BROKER | Other commissions Service code 55 | 300 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 | 454 | 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) | 459 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 835 | $2.8M |
| Dental | AETNA LIFE INSURANCE CO. | 835 | $2.8M |
| Vision | AETNA LIFE INSURANCE CO. | 835 | $2.8M |
| Life insurance | AETNA LIFE INSURANCE CO. | 835 | $2.8M |
| Short-term disability | AETNA LIFE INSURANCE CO. | 835 | $2.8M |
| Long-term disability | AETNA LIFE INSURANCE CO. | 835 | $2.8M |
| Other(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 835 | $2.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 835 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.