| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HARDEN & ASSOCIATES3 | 501 RIVERSIDE AVE STE 1000 JACKSONVILLE, FL 32202 | BLUE CROSS BLUE SHIELD OF FLORIDA | $59K | $0 | $59K | 4.00% |
| HARDEN & ASSOCIATES3 Filed as: HARDEN AND ASSOCIATES INC | 501 RIVERSIDE AVENUE SUITE 1000 JACKSONVILLE, FL 32202 | HEALTH OPTIONS INC | $20K | $0 | $20K | 4.00% |
| HARDEN & ASSOCIATES3 Filed as: HARDEN & ASSOCIATES INC | 501 RIVERSIDE AVE STE 1000 JACKSONVILLE, FL 322024941 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $61 | $8K | 9.29% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC | 175 S 3RD ST STE COLUMBUS, OH 432155194 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 1.26% |
| HARDEN & ASSOCIATES3 | 501 RIVERSIDE AVENUE SUITE 1000 JACKSONVILLE, FL 32202 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $2K | $7K | 15.46% |
| HARDEN & ASSOCIATES3 | 501 RIVERSIDE AVENUE SUITE 1000 JACKSONVILLE, FL 32202 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $3K | $7K | 16.23% |
| SALLY L PITTMAN3 | 9372 COXWELL LANE JACKSONVILLE, FL 32221 | AFLAC | $421 | $53 | $474 | 3.44% |
| HARDEN & ASSOCIATES3 Filed as: HARDEN & ASSOCIATES INC | 501 RIVERSIDE AVENUE SUITE 1000 JACKSONVILLE, FL 32202 | AFLAC | $234 | $0 | $234 | 1.70% |
| DENNIS PITTMAN3 | 9372 COXWELL LANE JACKSONVILLE, FL 32221 | AFLAC | $227 | $0 | $227 | 1.65% |
| JAMES ARTHUR HARBOUR3 | 1100 ALAKEA STREET SUITE 3200 HONOLULU, HI 96813 | AFLAC | $159 | $0 | $159 | 1.15% |
| DAVID C SWEIGARD3 | 2575E PELLICER RD ST AUGUSTINE, FL 32092 | AFLAC | $97 | $11 | $108 | 0.78% |
| JIMMY D BOONE3 | 5346 DOMINICA CIRCLE SARASOTA, FL 34233 | AFLAC | $103 | $0 | $103 | 0.75% |
| DAVID MARKS3 | 4021 WE HECK CT BLDG J BATON ROUGE, LA 70816 | AFLAC | $84 | $11 | $95 | 0.69% |
| THOMAS JAMES OLLER3 | 2010 COPPER CREEK DR UNIT C FLEMING ISLAND, FL 32003 | AFLAC | $94 | $0 | $94 | 0.68% |
| DAVID K MOBLEY3 | 3812 VALVERDE CIR JACKSONVILLE, FL 32224 | AFLAC | $76 | $0 | $76 | 0.55% |
| VERA I CRUICE3 | 7121 TARPON COURT FLEMING ISLAND, FL 32003 | AFLAC | $67 | $0 | $67 | 0.49% |
| DAVID C SWEIGARD3 | 283 VENETIAN BLVD ST AUGUSTINE, FL 32095 | AFLAC | $50 | $0 | $50 | 0.36% |
| CHRIS GUZEWICH3 | 1007 DRAKE FEATHER DRIVE ORANGE PARK, FL 32065 | AFLAC | $35 | $0 | $35 | 0.25% |
| J C ADAMS INC3 | 5631 NE 31ST TER OCALA, FL 34479 | AFLAC | $32 | $0 | $32 | 0.23% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: CRAIG H BROWN | 1303 AUBURN LAKES CIR VENICE, FL 34292 | AFLAC | $31 | $0 | $31 | 0.23% |
| SHELLIE GASKINS3 Filed as: SHELLIE L GASKINS | 510 22ND STREET ST AUGUSTINE, FL 32084 | AFLAC | $30 | $0 | $30 | 0.22% |
| BETH LUANNE KIMBROUGH3 | 6750 N ANDREWS AVE STE 200 FT LAUDERDALE, FL 33309 | AFLAC | $17 | $11 | $28 | 0.20% |
| J W GRIMES INC3 | 7659 HERITAGE CROSSING WAY REUNION, FL 34747 | AFLAC | $23 | $0 | $23 | 0.17% |
| ASHLEY CROOK3 Filed as: ASHLEY L CROOK | 111 DAUPHIN ST MOBILE, AL 36602 | AFLAC | $13 | $0 | $13 | 0.09% |
| TROY DANIEL DESLATTE3 | 107 SHADY PARK DR LAFAYETTE, LA 70508 | AFLAC | $9 | $0 | $9 | 0.07% |
| CASE PEARLMAN CORP BENEFITS INC3 | 7780 CAMBRIDGE MANOR PL STE B FT MYERS, FL 33907 | AFLAC | $9 | $0 | $9 | 0.07% |
| HAROLD L STAFFORD3 | 15655 77TH TRL N PALM BEACH GARDENS, FL 33418 | AFLAC | $8 | $0 | $8 | 0.06% |
| ROBERT VICTOR WOERNER II3 | 1548 WATERBRIDGE CT FLEMING ISLAND, FL 32003 | AFLAC | $7 | $0 | $7 | 0.05% |
| DEXTER ANTONIO HARRIS3 | 100 GALLERIA PARKWAY SUITE 900 ATLANTA, GA 30339 | AFLAC | $5 | $0 | $5 | 0.04% |
| JOHN J ASTOR3 | 2500 QUANTUM LAKES DR STE 203 BOYNTON BEACH, FL 33426 | AFLAC | $3 | $0 | $3 | 0.02% |
| ROBERT L TRAPNELL JR3 | 19 N INDIAN RIVER DRIVE APT 701 COCOA, FL 32922 | AFLAC | $1 | $0 | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFEWORKS US INC. EIN 81-1114266 CONTRACT ADMI NISTRATOR | Contract Administrator Service code 13 | 3311 E OLD SHAKOPEE RD MINNEAPOLIS, MN 55425 | $5K |
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 | 138 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF FLORIDA | 82 | $1.5M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 346 | $90K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 346 | $90K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 138 | $43K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 134 | $41K |
| Other(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF FLORIDA | 138 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 346 | — |
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.