| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JORDAN DYNAMICS3 Filed as: JORDAN DYNAMICS INC | 11641 KEW GARDENS AVE STE 111 PALM BEACH GARDENS, FL 33410 | BLUE CROSS BLUE SHIELD OF FLORIDA | $66K | — | $66K | 3.00% |
| UNITED BENEFIT ADVISORS OF FLORIDA3 | 6885 BELFORT OAKS PLACE STE 210 JACKSONVILLE, FL 32216 | PRINCIPAL LIFE INSURANCE COMPANY | $19K | $834 | $20K | 12.53% |
| JORDAN DYNAMICS5 Filed as: JORDAN DYNAMICS INC | 11641 KEW GARDENS AVE STE 111 PALM BEACH GARDENS, FL 33410 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $12K | — | $12K | 12.74% |
| WEB TPA5 | 8500 FREEPORT PKWY SOUTH IRVING, TX 75063 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $6K | — | $6K | 6.62% |
| AMWINS5 Filed as: AMWINS GROUP BENEFIT LLC | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $6K | $0 | $6K | 6.12% |
| IMPACT INTERACTIVE LLC5 | P.O. BOX 603188 CHARLOTTE, NC 28260 | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | $2K | — | $2K | 1.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FIDELITY INVESTMENTS INSTITUTIONAL EIN 04-2647786 RECORDKEEPER | Participant loan processing; Account maintenance fees; Recordkeeping fees Service code 37 | — | $0 |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRANSAMERICA INSURANCE CO. MEDICARE SUPPLEMENT | 126 | $90K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 251 | $160K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 251 | $160K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 251 | $160K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 251 | $160K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 251 | $160K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 251 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.