| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREEN HAZEL ASSOCIATES INC3 | 10739 DEERWOOD PARK BLVD JACKSONVILLE, FL 32256 | METROPOLITAN LIFE INSURANCE COMPANY | $22K | $1K | $24K | 11.21% |
| HYLANT GROUP INC3 | MADISON AVE TOLEDO, OH 43604 | METROPOLITAN LIFE INSURANCE COMPANY | — | $36 | $36 | 0.02% |
| GREEN HAZEL ASSOCIATES INC3 | DEERWOOD PARK BLVD, SUITE 200 JACKSONVILLE, FL 32256 | AETNA LIFE INSURANCE CO | $27K | — | $27K | 15.03% |
| CREATIVE WORKSITE SOLUTIONS LLC3 Filed as: CREATIVE WORKSITE SOLUTIONS | 3404 SALTERBECK STREET MT PLEASANT, SC 29466 | ALLSTATE | $5K | — | $5K | 11.09% |
| HYLANT GROUP INC3 | 7077 BONNEVAL ROAD JACKSONVILLE, FL 32216 | ALLSTATE | $3K | — | $3K | 5.48% |
| GREEN HAZEL ASSOCIATES INC3 | 10739 DEERWOOD PARK BLVD JACKSONVILLE, FL 32256 | ALLSTATE | $887 | — | $887 | 1.80% |
| DWIGHT L PIERCE3 Filed as: DWIGHT PIERCE | BENEFITS SERVICES GRP, 8833 PERMETE JACKSONVILLE, FL 32216 | ALLSTATE | $72 | — | $72 | 0.15% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHEILD OF FL IN EIN 59-2015694 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | 4800 DEARWOOD CAMPUS PARKWAY JACKSONVILLE, FL 32246 | $321K |
| GREENE-HAZEL & ASSOCIATES, INC EIN 59-2447356 BROKER | Other commissions Service code 55 | 10739 DEERWOOD PARK BLVD JACKSONVILLE, FL 32256 | $25K |
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 | 692 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 692 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. | 461 | $223K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 886 | $213K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 886 | $213K |
| Life insurance | AETNA LIFE INSURANCE CO | 692 | $178K |
| Short-term disability | AETNA LIFE INSURANCE CO | 692 | $178K |
| Long-term disability | AETNA LIFE INSURANCE CO | 692 | $178K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. | 461 | $174K |
| Other | AETNA LIFE INSURANCE CO | 692 | $178K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 886 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.