| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | BLUE CROSS BLUE SHIELD OF FLORIDA | $14K | — | $14K | 5.00% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | BLUE CROSS BLUE SHIELD OF FLORIDA | $10K | — | $10K | 5.00% |
| EXCALIBUR FINANCIAL GROUP3 Filed as: EXCALIBUR FINANCIAL GROUP INC | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | AETNA LIFE INSURANCE CO | $4K | $112 | $4K | 12.00% |
| EXCALIBUR FINANCIAL GROUP3 Filed as: EXCALIBUR FINANCIAL GROUP INC | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | GUARDIAN | $3K | — | $3K | 10.00% |
| HARRISON-DAVIS INC3 | 5426 BAY CENTER DR STE 550 TAMPA, FL 33609 | GUARDIAN | $236 | — | $236 | 0.75% |
| EXCALIBUR FINANCIAL GROUP3 Filed as: EXCALIBUR FINANCIAL GROUP INC | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 4.62% |
| YOLANDA TRISTANCHO-HELWIG3 | 449 CENTRAL AVE SAINT PETERSBURG, FL 33701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $493 | $16 | $509 | 2.05% |
| RONALD SADOFSKY3 | 2827 TORRANCE DRIVE LAND OLAKES, FL 34638 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $132 | — | $132 | 0.53% |
| JEFFERY C FABRIZIO3 | 160 COLUMBIA DR TAMPA, FL 33606 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $127 | $1 | $128 | 0.52% |
| JOSHUA A ZIMMERMAN3 | 302 KNIGHTS RUN AVE TAMPA, FL 33602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $66 | — | $66 | 0.27% |
| ANDERSON BENEFIT SOLUTIONS3 | 7408 VAN DYKE ROAD ODESSA, FL 33556 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.16% |
| CHOICE BENEFIT SOLUTIONS INC3 | 7408 VAN DYKE ROAD ODESSA, FL 33556 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.15% |
| STEVEN VERMETTE INC3 | 920 SPRING PARK LOOP CELEBRATION, FL 34747 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.13% |
| JADE COMPANIES LLC3 Filed as: JADE ALEXANDRA DAVIS | 215 CENTRAL AVE #3H ST PETERSBURG, FL 33701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.12% |
| TRILOGY BENEFITS CONSULTING LLC3 | 5908 HAMMOCK WOODS DRIVE ODESSA, FL 33556 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $10 | $24 | 0.10% |
| MICHAEL D MCMULLEN3 | 3726 VILLAGE ESTATES PLACE TAMPA, FL 33618 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.04% |
| HEIL BUSINESS SOLUTIONS CORPORATION3 Filed as: HEIL BUSINESS SOLUTIONS CORP | 4921 PENNSBURY DRIVE TAMPA, FL 33624 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $3 | $11 | 0.04% |
| EXCALIBUR FINANCIAL GROUP3 Filed as: EXCALIBUR FINANCIAL GROUP INC | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | ADVANTICA REINSURANCE COMPANY | $789 | — | $789 | 15.00% |
| KIMBERLY A BUCKLEW3 | 2281 CRYSTALVIEW CT LAKELAND, FL 33801 | AFLAC | $117 | — | $117 | 3.31% |
| HARRY M WIMER III INC3 | 4440 LENNI CIR EMMAUS, PA 18049 | AFLAC | $67 | — | $67 | 1.89% |
| RUBY ROBB3 | 3216 THACKERY WAY PLANT CITY, FL 33566 | AFLAC | $65 | — | $65 | 1.84% |
| OMER S BASS IV3 | 565 W GATEWAY CT MERRITT ISLAND, FL 32952 | AFLAC | $36 | — | $36 | 1.02% |
| HEARTLAND BENEFITS INC3 | 233 EAST CENTER AVE SEBRING, FL 33870 | AFLAC | $33 | — | $33 | 0.93% |
| THE PERRY GROUP INC3 | 1650 SAND LAKE RD STE 201D ORLANDO, FL 32809 | AFLAC | $25 | — | $25 | 0.71% |
| CYNTHIA M WIMER3 | 4440 LENNI CIR EMMAUS, PA 18049 | AFLAC | $19 | — | $19 | 0.54% |
| BARTLEIN AND ASSOC INC3 | 5577 BROADCAST COURT SARASOTA, FL 34240 | AFLAC | $13 | — | $13 | 0.37% |
| ROBERT L TRAPNELL JR3 | 15 N INDIAN RIVER DR APT 705 COCOA, FL 32922 | AFLAC | $8 | — | $8 | 0.23% |
| JULIE TRULUCK3 | 1934 PANTHEON DR WINTER GARDEN, FL 34787 | AFLAC | $6 | — | $6 | 0.17% |
| J W GRIMES INC3 | 7659 HERITAGE CROSSING WAY REUNION, FL 34747 | AFLAC | $2 | — | $2 | 0.06% |
| EXCALIBUR FINANCIAL GROUP3 Filed as: EXCALIBUR FINANCIAL GROUP INC | 302 KNIGHTS RUN AVE STE 110 TAMPA, FL 33602 | METROPOLITAN LIFE INSURANCE COMPANY | $244 | $128 | $372 | — |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 146 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS BLUE SHIELD OF FLORIDA | 40 | $475K |
| Dental(2 contracts, 2 carriers) | GUARDIAN | 66 | $31K |
| Vision | ADVANTICA REINSURANCE COMPANY | 71 | $5K |
| Life insurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO | 146 | $57K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 35 | $28K |
| Long-term disability | AETNA LIFE INSURANCE CO | 146 | $33K |
| Prescription drug(2 contracts) | BLUE CROSS BLUE SHIELD OF FLORIDA | 40 | $475K |
| Other | AETNA LIFE INSURANCE CO | 146 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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.