| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OMS OF NORTHWEST FLORIDA INC3 Filed as: OMS OF NORTHWEST FLORIDA INC. | PO BOX 1097 SANTA ROSA BEACH, FL 32459 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17K | $2K | $19K | 9.29% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | — | $10K | 5.00% |
| SHAUNET LOUISE PROKUSKI3 | PO BOX 2 LAKELAND, FL 33802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $4 | $2K | 0.87% |
| DARCIPRETE AND ASSOCIATES INC3 Filed as: DARCIPRETE & ASSOCIATES INC. | 12945 US HIGHWAY 331 MONTGOMERY, AL 36105 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $349 | $478 | $827 | 0.40% |
| JOEY MIGUES3 Filed as: JOEY GRUBBS BENEFITS LLC | 4527 ARGLE LN TALLAHASSEE, FL 32309 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $160 | $108 | $268 | 0.13% |
| ROSA SHALA3 | 16112 HARBOUR VISTA CIR ST AUGUSTINE, FL 32080 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $223 | — | $223 | 0.11% |
| REUBEN F JACOBS JR3 | 868 LAKE JACKSON CIRCLE APOPKA, FL 32703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | — | $115 | 0.06% |
| ALLEGIAN BENEFITS & SERVICES LLC3 | 7512 DR PHILLIPS BLVD ORLANDO, FL 32819 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $89 | — | $89 | 0.04% |
| COACH CONCEPTS INC3 Filed as: COACH CONCEPTS INC. | 9500 KOGER BLVD ST PETERSBURG, FL 33702 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $6 | $39 | 0.02% |
| CTL SERVICES INC3 | 1140 CLIMBING ROSE DR ORLANDO, FL 32818 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.02% |
| SAPOZNIK INSURANCE & ASSOCIATES INC3 Filed as: SAPOZNIK INS & ASSOC INC | 1100 NE 163RD STREET N MIAMI BEACH, FL 33162 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.01% |
| WILLIAM RENNARD3 | 33001 ALOMA AVE WINTER PARK, FL 32792 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $5 | $12 | 0.01% |
| B & B INSURANCE SOLUTIONS INC3 Filed as: B & B INSURANCE SOLUTIONS INC. | 14716 SW 112 TERRACE MIAMI, FL 33196 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.00% |
| RAYMOND C GRAY3 | 34431 SHADEWOOD CIR LEESBURG, FL 34788 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| ANDREA BROWNING3 | 145 19TH AVE SE ST PETERSBURG, FL 33705 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | DELTA DENTAL INSURANCE CARRIER | $19K | — | $19K | 10.00% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | SUN LIFE ASSURANCE COMPANY OF CANADA | $13K | — | $13K | 12.43% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | SUN LIFE ASSURANCE COMPANY OF CANADA | $13K | — | $13K | 12.99% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | SUN LIFE INSURANCE COMPANY OF CANADA | $10K | — | $10K | 12.18% |
| OMS INSURANCE GROUP3 | 26 LAKE WIRE DR LAKELAND, FL 33815 | AMERITAS LIFE INSURANCE CORP | $4K | $710 | $4K | 11.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX EIN 33-0441200 PHARMACY BENEFIT MANAGER | Other fees; Direct payment from the plan; Claims processing; Float revenue Service code 12 | — | $599K |
| UMR INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $370K |
| OMS INSURANCE GROUP EIN 59-3757026 BROKER | Other commissions Service code 55 | PO BOX 2 LAKELAND, FL 33802 | $96K |
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 | 577 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 577 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL INSURANCE CARRIER | 615 | $188K |
| Vision | AMERITAS LIFE INSURANCE CORP | 699 | $38K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 577 | $311K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 272 | $306K |
| Long-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 243 | $289K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 416 | $304K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 699 | — |
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.