| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | — | SYMETRA LIFE INSURANCE COMPANY | — | $16K | $16K | 3.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ERWIN LAX EIN 59-0834277 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $195K |
| LORRAINE WILLIAMS EIN 59-0834277 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $124K |
| ANTHONY L ROUNDTREE EIN 59-0834277 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $117K |
| CYNTHIA POWELL EIN 59-0834277 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $101K |
| TOYER T DORSEY EIN 59-0834277 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $87K |
| VENTURE POINT NONE | Direct payment from the plan; Consulting (general) Service code 16 | 8659 BAYPINE ROAD SUITE 106 JACKSONVILLE, FL 32256 | $75K |
| TERRIE Y JACHO-SWANIGAN EIN 59-0834277 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $63K |
| THE LAW OFFICE OF RICHARD K JONES NONE | Legal; Direct payment from the plan Service code 29 | 2950 HALCYON LANE, UNIT 303 JACKSONVILLE, FL 32223 | $45K |
| CHARO SIMPSON EIN 59-0834277 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $45K |
| SCHULTHEIS & PANETTIERI LLP EIN 13-1577780 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $43K |
| WYNETTA MCGRAW EIN 59-0834277 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $33K |
| THE LAMBOS FIRM EIN 13-3864093 NONE | Legal; Direct payment from the plan Service code 29 | — | $26K |
| GEOGRAMETRIX INC NONE | Consulting (general); Direct payment from the plan Service code 16 | 9838 OLD BAYMEADOWS RD JACKSONVILLE, FL 32256 | $23K |
| JOHN E. SANDS NONE | Legal; Direct payment from the plan Service code 29 | 7777 GLADES ROAD SUITE 100 BOCA RATON, FL 33434 | $16K |
| THE SEGAL COMPANY (SOUTHEAST) INC. NONE | Direct payment from the plan; Actuarial Service code 11 | PO BOX 4125 CHURCH STREET STATION NEW YORK, NY 102614125 | $12K |
| ELAN FINANCIAL SERVICES NONE | Consulting (general); Direct payment from the plan Service code 16 | P.O. BOX 790408 ST. LOUIS, MO 631790408 | $7K |
| SMITH, GAMBRELL & RUSSELL, LLP EIN 58-0967450 NONE | Legal; Direct payment from the plan Service code 29 | — | $5K |
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 | 589 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 176 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 139 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 765 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 765 | $413K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 765 | $413K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 765 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.