| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EXCALBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN #110 TAMPA, FL 33602 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $43K | — | $43K | 3.70% |
| ROGER BOUCHARD INSURANCE INC3 | PO BOX 6090 CLEARWATER, FL 33758 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $20K | — | $20K | 1.69% |
| ROBERT FABRIZIO3 Filed as: ROBERT BRIAN FABRIZIO | 302 KNIGHTS RUN #110 TAMPA, FL 33602 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 4.76% |
| WILLIAM MANNIX3 | 302 KNIGHTS RUN #110 TAMPA, FL 33602 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 4.76% |
| BOUCHARD INSURANCE3 | 101 STARCREST DR PO BOX 6090 CLEARWATER, FL 33758 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 4.65% |
| VARIOUS - SEE ATTACHED3 | 302 KNIGHTS RUN STE 110 TAMPA, FL 33602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $504 | $9K | 11.24% |
| EXCALIBUR FINANCIAL GROUP3 Filed as: EXCALIBUR FINANCIAL FINANCIAL GROUP | 302 KNIGHTS RUN #110 TAMPA, FL 33602 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 12.81% |
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 | 118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 171 | $1.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 227 | $130K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 193 | $14K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 227 | $130K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 227 | $130K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 82 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 227 | — |
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.