| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HARDEN & ASSOCIATES3 Filed as: HARDEN AND ASSOCIATES INC | 501 RIVERSIDE AVE SUITE 1000 JACKSONVILLE, FL 32202 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $19K | — | $19K | 5.98% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | TRANSAMERICA LIFE INSURANCE COMPANY | $21K | — | $21K | 7.14% |
| BUSINESS PLANNING CONCEPTS3 Filed as: BUSINESS PLANNING CONCEPTS INC | 7645 GATE PARKWAY SUITE 101 JACKSONVILLE, FL 32256 | TRANSAMERICA LIFE INSURANCE COMPANY | $17K | — | $17K | 5.96% |
| MITCH BESVINICK3 | 1280 BRIGHTON WAY NEW TOWN SQUARE, PA 19073 | TRANSAMERICA LIFE INSURANCE COMPANY | $7K | — | $7K | 2.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA EIN 59-2015694 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $799K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 PLAN ADMINISTRATION | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Plan Administrator; Claims processing Service code 12 | — | $170K |
| KEY BENEFIT ADMINISTRATORS EIN 35-1450364 PLAN ADMINISTRATION | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator Service code 12 | — | $15K |
| MITCH BESVINICK INSURANCE BROKER | Insurance services; Insurance agents and brokers Service code 22 | 1280 BRIGHTON WAY NEW TOWN SQUARE, PA 19073 | $6K |
| DIGITAL INSURANCE EIN 58-2522668 INSURANCE BROKER | Insurance services; Insurance agents and brokers Service code 22 | — | $6K |
| MULTIPLAN EIN 35-2048379 PLAN ADMINISTRATION | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Contract Administrator Service code 12 | — | $5K |
| BUSINESS PLANNING CONCEPTS INC EIN 59-2442511 22 | Plan Administrator; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $4K |
| RGI LLC EIN 32-0176370 CLAIMS PROCESSING | Plan Administrator; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $4K |
| HARDEN AND ASSOCIATES | Insurance agents and brokers Service code 22 | — | $2K |
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 | 2,117 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 2,126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 274 | $296K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,474 | $680K |
| Vision(2 contracts) | HUMANA INSURANCE COMPANY OF NE | 1,228 | $116K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,117 | $415K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 929 | $190K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 761 | $299K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,117 | $327K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,117 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.