| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STACEY OSIECKI3 | 3520 THOMASVILLE RD SUITE 500 TALLAHASSEE, FL 32309 | CAPITAL HEALTH PLAN | $16K | — | $16K | 2.78% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 3520 THOMASVILLE RD STE 500 TALLAHASSEE, FL 323093435 | BLUE CROSS BLUE SHIELD OF FLORIDA | $916 | — | $916 | 0.71% |
| SHAPIRO INSURANCE INC.3 | PO BOX 13769 TALLAHASSEE, FL 32317 | BLUE CROSS BLUE SHIELD OF FLORIDA | $558 | — | $558 | 0.43% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 6611 ORION DRIVE SUITE 201 FORT MYERS, FL 33912 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $3K | $9K | 13.03% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA | 220 S. RIDGEWOOD AVENUE STE 500 DAYTONA BEACH, FL 32114 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $108 | — | $108 | 0.16% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS-SEE ATTACHED | — | AFLAC | $6K | $268 | $6K | 23.28% |
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 | 131 | 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) | 131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CAPITAL HEALTH PLAN | 105 | $709K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 131 | $68K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 131 | $68K |
| Short-term disability | AFLAC | 39 | $25K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 131 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 131 | — |
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.