| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES,LLC | PO BOX 62689 VIRGINIA BEACH, VA 234662689 | HEALTH OPTIONS / BLUE CROSS BLUE SHIELD OF FLORIDA | $45K | — | $45K | 4.05% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES,LLC | PO BOX 62689 VIRGINIA BEACH, VA 234662689 | BLUE CROSS BLUE SHIELD OF FLORIDA | $37K | — | $37K | 4.05% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 234662689 | FLORIDA COMBINED LIFE | $4K | — | $4K | 10.04% |
| FLORIDA BLUE3 | 4800 DEERWOOD CAMPUS PKWY JACKSONVILE, FL 32246 | FLORIDA COMBINED LIFE | $277 | — | $277 | 0.64% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL ST BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 12.56% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62689 VIRGINIA BEACH, VA 234662689 | FLORIDA COMBINED LIFE | $1K | — | $1K | 9.44% |
| FLORIDA BLUE3 | 4800 DEERWOOD CAMPUS PKWY # DC2/2 JACKSONVILLE, FL 32246 | FLORIDA COMBINED LIFE | $114 | — | $114 | 1.04% |
| A & E BENEFITS GROUP LLC3 | 17157 BALBOA POINT WAY BOCA RATON, FL 334871012 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62689 VIRGINIA BEACH, VA 23466 | BLUE CROSS BLUE SHIELD OF FLORIDA INC. | $729 | — | $729 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIVERSIFIED ADMINISTRATION, INC. EIN 65-0362462 FSA ADMINISTRATOR | Contract Administrator Service code 13 | 6600 TAFT STREET STE 304 HOLLYWOOD, FL 33023 | $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 | 123 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH OPTIONS / BLUE CROSS BLUE SHIELD OF FLORIDA | 50 | $2.0M |
| Dental(2 contracts) | FLORIDA COMBINED LIFE | 71 | $54K |
| Vision | BLUE CROSS BLUE SHIELD OF FLORIDA INC. | 45 | $7K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $10K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 107 | $26K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH OPTIONS / BLUE CROSS BLUE SHIELD OF FLORIDA | 50 | $2.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.