| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INSURANCE | 101 STARCREST DRIVE NORTH CLEARWATER, FL 33765 | AETNA HEALTH, INC | $3K | $2K | $6K | 0.33% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INSURANCE | P O BOX 6090 CLEARWATER, FL 337586090 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 7.00% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GOURP INC. | 5110 N 40TH ST STE 234 PHOENIX, AZ 850182151 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 2.83% |
| ADAMS GROUP INSURANCE INC.3 | 7441 N. TAMIAMI TRAIL SARASOTA, FL 34243 | RELIANCE STANDARD INSURANCE COMPANY | $8K | $5K | $13K | 19.42% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INSURANCE | 101 STARCREST DR CLEARWATER, FL 337653225 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $662 | $5K | 17.41% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INSURANCE | P.O. BOX 6090 CLEARWATER, FL 33758 | HUMANA | $1K | $328 | $1K | 12.86% |
No Schedule C service providers reported on this filing.
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 | 167 | 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) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA HEALTH, INC | 215 | $1.7M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $104K |
| Vision | HUMANA | 102 | $11K |
| Life insurance(2 contracts, 2 carriers) | RELIANCE STANDARD INSURANCE COMPANY | 139 | $93K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 35 | $27K |
| Long-term disability | RELIANCE STANDARD INSURANCE COMPANY | 139 | $66K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD INSURANCE COMPANY | 139 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.