| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $738 | — | $738 | 10.00% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | SUN LIFE ASSURANCE COMPANY OF CANADA | $875 | — | $875 | 15.01% |
| OMS OF NORTHWEST FLORIDA INC3 | PO BOX 1097 SANTA ROSA BEACH, FL 32459 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $469 | $122 | $591 | 10.69% |
| OMS INSURANCE GROUP3 Filed as: OMS INSURANCE GROUP LLC | PO BOX 2 LAKELAND, FL 33802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $270 | — | $270 | 4.88% |
| EDWARD ALBERT GUY JR3 Filed as: EDWARD GUY | 736 RED FERN RD TALLAHASSEE, FL 32308 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $104 | $53 | $157 | 2.84% |
| JOEY MIGUES3 Filed as: JOEY GRUBBS BENEFITS LLC | 4527 ARGYLE LN TALLAHASSEE, FL 32309 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $7 | $54 | 0.98% |
| NICOLE TOWNSEND VEDDER3 | 3370 LAKE RUN DR TALLAHASSEE, FL 32309 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $14 | $47 | 0.85% |
| ASHLEY WIMBERLEY SKELTON3 Filed as: ASHLEY WIMBERLY | 1300 MAGNOLIA CURVE MONTGOMERY, AL 36106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.27% |
| DAVID J MCCLELLAN3 Filed as: DAVID B MERKHOFER | 2704 SETTER PL TALLAHASSEE, FL 32303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $4 | $12 | 0.22% |
| ALICIA MARCUM3 | 1122 GRAND ST APT 505 HOBOKEN, NJ 07030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.14% |
| THOMAS WALLACE JR3 | PO BOX 3654 PONTE VEDRA, FL 32004 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.14% |
| ALFORD INSURANCE SERVICES INC3 | 868 STONE RD GRAND RIDGE, FL 32442 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.11% |
| PHILLIP CAIN3 | PO BOX 1322 SNEADS, FL 32460 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.07% |
| ANDREA BROWNING3 | 145 19TH AVE SE ST PETERSBURG, FL 33705 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.04% |
| DARCIPRETE AND ASSOCIATES INC3 Filed as: DARCIPRETE & ASSOCIATES | 12945 US HIGHWAY 331 MONTGOMERY, AL 36105 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.02% |
| MARY SUSANNE MERKHOFER3 | 2704 SETTER PL TALLAHASSEE, FL 32303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $12K |
| OMS INSURANCE GROUP EIN 59-3757026 BROKER | Other commissions Service code 55 | PO BOX 2 LAKELAND, FL 33802 | $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 | 170 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 170 | $7K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 170 | $7K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 122 | $11K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 122 | $11K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 122 | $6K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 159 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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.