| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RICHARD S. BERNSTEIN & ASSOCIATES3 Filed as: RICHARD S BERNSTEIN & ASSOCIATES | 1551 FORUM PLACE 300 A WEST PALM BEACH, FL 33401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $3K | $10K | 2.85% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | STANDARD INSURANCE COMPANY | $5K | $11K | $17K | 7.68% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 951 YAMATO ROAD SUITE 200W BOCA RATON, FL 33431 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $8K | $16K | 9.63% |
| RICHARD S. BERNSTEIN & ASSOCIATES3 Filed as: RICHARD S BERNSTEIN & ASSOCIATES | 1551 FORUM PL 300 A WEST PALM BEACH, FL 33401 | UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 3.29% |
| SMITH, THOMAS, CHRISTOPHER3 Filed as: SMITH, THOMAS CHRISTOPHER | PO BOX 6650 METAIRIE, LA 70009 | UNUM LIFE INSURANCE COMPANY | $299 | — | $299 | 0.55% |
| RICHARD S. BERNSTEIN & ASSOCIATES3 Filed as: RICHARD S BERNSTEIN & ASSOCIATES | 1551 FORUM PLACE 300 A WEST PALM BEACH, FL 33401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $328 | $7K | 15.61% |
| ADAMS BENEFIT CORPORATION3 Filed as: ADAMS BENEFIT CORP. (BOR) | 600 CORPORATE DRIVE, SUITE 650 FORT LAUDERDALE, FL 33334 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | $3K | — | $3K | 11.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIVERSIFIED ADMINISTRATION, INC. EIN 65-0362462 THIRD PARTY ADMINISTRATO | Contract Administrator; Claims processing Service code 12 | 6161 WASHINGTON STREET HOLLYWOOD, FL 33023 | $11K |
| AETNA BEHAVIORAL HEALTH, LLC PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVENUE RSSA HARTFORD, CT 06156 | $7K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 BROKER | Insurance agents and brokers Service code 22 | — | $0 |
| WEEKES & CALLAWAY, INC. EIN 59-0714699 BROKER | Insurance agents and brokers Service code 22 | — | $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 | 392 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 399 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 355 | $4.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 265 | $167K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INSURANCE | 472 | $25K |
| Life insurance | STANDARD INSURANCE COMPANY | 392 | $215K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $44K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 378 | $366K |
| Other | UNUM LIFE INSURANCE COMPANY | 174 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 472 | — |
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.