| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EXCALIBUR FINANCIAL GROUP3 | 4830 WEST KENNEDY BLVD SUITE 550 TAMPA, FL 33609 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $205K | $205K | 3.23% |
| EXCALIBUR FINANCIAL GROUP3 | 4830 WEST KENNEDY BLVD SUITE 550 TAMPA, FL 33609 | METROPOLITAN LIFE INSURANCE COMPANY | $50K | $21 | $50K | 11.22% |
| ROBERT FABRIZIO3 | 4830 WEST KENNEDY BLVD SUITE 550 TAMPA, FL 33609 | PRINCIPAL LIFE INSURANCE COMPANY | $22K | $0 | $22K | 6.91% |
| WILLIAM MANNIX3 | 4830 WEST KENNEDY BLVD SUITE 550 TAMPA, FL 33609 | PRINCIPAL LIFE INSURANCE COMPANY | $22K | $0 | $22K | 6.91% |
| EXCALIBUR FINANCIAL GROUP3 | 4830 WEST KENNEDY BLVD SUITE 550 TAMPA, FL 33609 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $8K | $8K | 2.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 CIGNA | Named fiduciary; Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Float revenue; Participant communication Service code 12 | — | $2K |
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 | 1,624 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,626 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 555 | $6.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 2,419 | $448K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 1,009 | $314K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 2,419 | $762K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 1,009 | $314K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 2,419 | $448K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,419 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.