| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | 500 W 13TH STREET FORT WORTH, TX 76102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $44K | — | $44K | 10.35% |
| STAHL & ASSOCIATES INSURANCE INC.3 Filed as: STAHL & ASSOCIATES INSURANCE, INC. | 110 CARILLON PARKWAY ST PETERSBURG, FL 33716 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | — | $6K | 1.32% |
| JOHN DOMEIER3 | 720 17TH AVENUE N ST. PETERSBURG, FL 33704 | AFLAC | $795 | $71 | $866 | 2.17% |
| WILLIS TOWERS WATSON US LLC3 Filed as: RODNEY WILLIS | 510 74TH AVENUE N SAINT PETERSBURG, FL 37702 | AFLAC | $679 | $71 | $750 | 1.88% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | 110 CARILLON PARKWAY ST. PETERSBURG, FL 33716 | AFLAC | $508 | — | $508 | 1.27% |
| VICTORRIO PAUL ZANIOL INC3 Filed as: VICTORRIO PAUL ZANOIL, INC. | 690 64TH STREET SOUTH ST. PETERSBURG, FL 33707 | AFLAC | $456 | — | $456 | 1.14% |
| JOYCE A FIORAVANTI3 | 11286 OAKRIDGE TRAIL DRIVE SEMINOLE, FL 33772 | AFLAC | $434 | — | $434 | 1.09% |
| LANCE SHNIDER3 Filed as: LANCE V SHNIDER | 401 EAST OGLETHORPE AVENUE APT 1114 SAVANNAH, GA 31401 | AFLAC | $284 | $21 | $305 | 0.76% |
| JAMIE PITTNER3 | 2749 BURNING TREE LANE CLEARWATER, FL 33761 | AFLAC | $213 | $21 | $234 | 0.59% |
| NORA M FOLKERS3 Filed as: NORA FOLKERS | 1121 CANE MILL LANE BRADENTON, FL 34212 | AFLAC | $196 | — | $196 | 0.49% |
| SANDRA WHITELEY3 | 488 SUGAR RIDGE COURT LONGWOOD, FL 32779 | AFLAC | $155 | — | $155 | 0.39% |
| ARNIE SAFERSTEIN3 | 3443 NW 60TH LANE GAINESVILLE, FL 32653 | AFLAC | $120 | — | $120 | 0.30% |
| JOSEPH BAILEY DUCKETT3 | 113 SILKY SULLIVAN WAY CANTON, GA 30115 | AFLAC | $116 | — | $116 | 0.29% |
| TIFFANY KINDLE MILLER3 Filed as: TIFFANY MILLER | 1600 BOXWOOD LANE WYLIE, TX 75098 | AFLAC | $80 | — | $80 | 0.20% |
| THOMAS A HOUSE3 Filed as: THOMAS HOUSE | 653 W OSCEOLA STREET, APT C CLERMONT, FL 34711 | AFLAC | $74 | — | $74 | 0.19% |
| DARRELL STANLEY BRANDIMORE3 | 3701 18TH AVENUE N SAINT PETERSBURG, FL 33713 | AFLAC | $72 | — | $72 | 0.18% |
| CURRY N KIMMEY JR3 | P.O. BOX 246 SAFETY HARBOR, FL 34695 | AFLAC | $54 | — | $54 | 0.14% |
| J W GRIMES INC3 Filed as: J W GRIMES, INC. | 8033 SPLENDOR WAY COLUMBUS, GA 31904 | AFLAC | $34 | — | $34 | 0.09% |
| SUSAN C BRIMHALL3 Filed as: SUSAN BRIMHALL | P.O. BOX 8 LAKE PLACID, NY 12946 | AFLAC | $34 | — | $34 | 0.09% |
| STEPHEN GRAZIANO3 | 3850 LEE ROAD 246 SMITH STATION, AL 36877 | AFLAC | $31 | — | $31 | 0.08% |
| KATHRYN SUZANNE AXENTE3 | 7020 PELICAN ISLAND DRIVE TAMPA, FL 33634 | AFLAC | $28 | — | $28 | 0.07% |
| KELLY A IRVINE3 Filed as: KELLY ANN IRVINE | 15801 WHITE ORCHID LANE FORT MYERS, FL 33908 | AFLAC | $25 | — | $25 | 0.06% |
| MITCHELL KOGGE3 | 5732 TORTOISE PLACE APOLLO BEACH, FL 33572 | AFLAC | $25 | — | $25 | 0.06% |
| JAMES ARTHUR HARBOUR3 | 7725 GATEWAY, UNIT 2503 IRVINE, CA 92618 | AFLAC | $23 | — | $23 | 0.06% |
| AIMEE BRANDON3 | 28322 OPENFIELD LOOP WESLEY CHAPEL, FL 33543 | AFLAC | $22 | — | $22 | 0.06% |
| JAMES (JAY) GRIMES3 | 614 ROBERT WILLIAMS ROAD PINE MOUNTAIN, GA 31822 | AFLAC | $16 | — | $16 | 0.04% |
| LAURA ALGREN3 | 17960 GULF BLVD, APT 114 REDINGTON SHORES, FL 33708 | AFLAC | $13 | — | $13 | 0.03% |
| VICTORIA BELLAVIA3 | 2427 BENTLEY DRIVE PALM HARBOR, FL 34684 | AFLAC | $13 | — | $13 | 0.03% |
| BARTLEIN AND ASSOC INC3 | 22465 PANTHER LOOP BRADENTON, FL 34202 | AFLAC | $12 | — | $12 | 0.03% |
| GARY WHITE3 | 129 BARBARA DRIVE PORT ST. JOE, FL 32456 | AFLAC | $11 | — | $11 | 0.03% |
| JEFFREY GLENN YARISH3 | 8575 SUNSET COURT TREASURE ISLAND, FL 33706 | AFLAC | $7 | — | $7 | 0.02% |
| DENNIS W CAMDEN3 Filed as: DENNIS CAMDEN | 101 N JEFFERSON ST, RM 305 MEXICO, MO 65265 | AFLAC | $6 | — | $6 | 0.02% |
| MARY REBECCA WEATHERLY3 | 273 WILLIAMSBURG DRIVE MT WASHINGTON, KY 40047 | AFLAC | $5 | — | $5 | 0.01% |
| GRAVES INC3 Filed as: GRAVES, INC. | 5659 W. HOLIDAY STREET HOMOSASSA, FL 34446 | AFLAC | $5 | — | $5 | 0.01% |
| JANINE FOX3 | 18 HAVILAND DRIVE SCHENECTADY, NY 12302 | AFLAC | $5 | — | $5 | 0.01% |
| FRANCIS V CRUZ3 Filed as: FRANCIS CRUZ | P.O. BOX 302 BRADFORDWOODS, PA 15015 | AFLAC | $4 | — | $4 | 0.01% |
| JAMES ARTHUR HARBOUR3 Filed as: JAMES A HARBOUR | 7725 GATEWAY, UNIT 2503 IRVINE, CA 92618 | AFLAC | $4 | — | $4 | 0.01% |
| MARK C LEE3 | 8229 FRANK HOUSER AVENUE COLUMBUS, GA 31909 | AFLAC | $3 | — | $3 | 0.01% |
| JESSICA RAE ESKEW3 | 10426 SPRINGROSE DRIVE TAMPA, FL 33626 | AFLAC | $2 | — | $2 | 0.01% |
| JENNIFER B MOREHEAD3 | 26267 WALKING HORSE TRAIL BROOKSVILLE, FL 34601 | AFLAC | $1 | — | $1 | 0.00% |
| HORACE R WEAVER III3 | P.O. BOX 910732 ST GEORGE, UT 84791 | AFLAC | $1 | — | $1 | 0.00% |
| KIMBERLY DIAN CROCKETT3 Filed as: KIMBERLY CROCKETT | 172 WALKING STICK DRIVE ELLERSLIE, GA 31807 | AFLAC | $1 | — | $1 | 0.00% |
| OMER S BASS IV3 Filed as: OMER BASS IV | 565 W GATEWAY COURT MERRITT ISLAND, FL 32952 | AFLAC | $1 | — | $1 | 0.00% |
| DELORES ELAINE PINKOWSKI3 | HC 64 BOX 1815 CASTLE VALLEY, UT 84532 | AFLAC | $1 | — | $1 | 0.00% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY | 500 W 13TH STREET FORT WORTH, TX 76102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 15.00% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY | 500 W 13TH STREET FORT WORTH, TX 76102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 15.00% |
| VERNON WALKER4 | 3507 BELLE VISTA DRIVE E ST. PETERSBURG, FL 33706 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $324 | — | $324 | 8.22% |
| CHERYL DAGATA DBA CAD & JAD CONSULT4 Filed as: CHERYL DAGATA DBA CAD & JAD CONS SV | 130 PROMINENCE PT PKWY STE 130-339 CANTON, GA 30114 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $186 | — | $186 | 4.72% |
| JOHN F ROWAN4 | 538 LINDSEY LAKE ROAD DALLAS, GA 30157 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $20 | — | $20 | 0.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACTIVE & FIT AMERICAN SPECIALTY HEA EIN 33-0883241 NONE | Non-monetary compensation; Contract Administrator; Direct payment from the plan; Participant communication; Claims processing; Float revenue; Named fiduciary; Other services Service code 12 | 10221 WATERRIDGE CIRCLE SAN DIEGO, CA 92121 | $0 |
| AMPLIFON HEARING HEALTHCARE EIN 85-0437037 NONE | Named fiduciary; Claims processing; Direct payment from the plan; Non-monetary compensation; Float revenue; Participant communication; Other services; Contract Administrator Service code 12 | FIFTH STREET TOWERS 150 SOUTH 5TH S SUITE 2300 MINNEAPOLIS, MN 55402 | $0 |
| CIGNA | Participant communication; Contract Administrator; Named fiduciary; Other services; Non-monetary compensation; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $0 |
| FITBIT EIN 20-8920744 NONE | Float revenue; Other services; Claims processing; Non-monetary compensation; Direct payment from the plan; Contract Administrator; Participant communication; Named fiduciary Service code 12 | 199 FREMONT STREET SAN FRANCISCO, CA 94105 | $0 |
| LASIK-LCA-VISION INC. EIN 11-2882328 NONE | Named fiduciary; Contract Administrator; Other services; Float revenue; Participant communication; Direct payment from the plan; Claims processing; Non-monetary compensation Service code 12 | 7840 MONTGOMERY ROAD CINCINNATI, OH 45236 | $0 |
| OMADA HEALTH, INC. EIN 45-2355015 NONE | Other services; Float revenue; Participant communication; Non-monetary compensation; Contract Administrator; Named fiduciary; Claims processing; Direct payment from the plan Service code 12 | 500 SANSOME STREET, #200 SAN FRANCISCO, CA 94111 | $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 | 90 | 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) | 90 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 81 | $467K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 90 | $58K |
| Short-term disability | AFLAC | 49 | $40K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 90 | $27K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 90 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 90 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.