| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS | PO BOX 2 LAKELAND, FL 33802 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $4K | $6K | 9.64% |
| BENETEK CORPORATION3 | 4275 WEST SAND LAKE RD ORLANDO, FL 32819 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.00% |
| HARRISON-DAVIS INC3 Filed as: HARRISON DAVIS INC | 5426 BAY CENTER DR TAMPA, FL 33609 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $17 | — | $17 | 0.03% |
| DAVIS II COMPANIES LLC3 Filed as: DAVIS II COMPANIES | 5426 BAY CENTER DR TAMPA, FL 33609 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9 | — | $9 | 0.01% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $125 | $2K | 16.03% |
| OMS INSURANCE GROUP5 | PO BOX 2 LAKELAND, FL 33802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $810 | $810 | 6.64% |
| WEB BENEFITS DESIGN CORPORATION5 Filed as: WEB BENEFITS DESING | 4725 W SAND LAKE RD STE 300 ORLANDO, FL 32819 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $166 | $166 | 1.36% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $83 | $1K | 16.13% |
| OMS INSURANCE GROUP5 | PO BOX 2 LAKELAND, FL 33802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $487 | $487 | 6.62% |
| WEB BENEFITS DESIGN CORPORATION5 Filed as: WEB BENEFITS DESING | 4725 SAND LAKE RD STE 300 ORLANDO, FL 32819 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $101 | $101 | 1.37% |
| OMS INSURANCE GROUP5 | PO BOX 2 LAKELAND, FL 33802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $399 | $399 | 6.62% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $301 | $52 | $353 | 5.86% |
| WEB BENEFITS DESIGN CORPORATION5 Filed as: WEB BENEFITS DESIGN | 4725 W SAND LAKE RD STE 300 ORLANDO, FL 32819 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $83 | $83 | 1.38% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | SUN LIFE ASSURANCE COMPANY OF CANADA | $789 | — | $789 | 15.18% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS | 4634 GULFSTARR DR DESTIN, FL 32541 | SUN LIFE ASSURANCE COMPANY OF CANADA | $172 | — | $172 | 3.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $100K |
| OMS INSURANCE GROUP EIN 59-3757026 BROKER | Other commissions Service code 55 | PO BOX 2 LAKELAND, FL 33802 | $50K |
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 | 137 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 137 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 68 | $62K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 68 | $62K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $20K |
| Short-term disability(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $25K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 35 | $6K |
| Stop-loss / reinsurancereinsurance | SWISS RE - WESTPOINT INSURANCE CORP | 109 | $254K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 12 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 137 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.