| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES OF FL | 700 CENTRAL PKWY STUART, FL 34994 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | $57K | $65K | 2.75% |
| EMPLOYERS MUTUAL INC.3 | 700 CENTRAL PKWY STUART, FL 349943967 | HUMANA INSURANCE COMPANY | $2K | — | $2K | 9.99% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES OF FL | 700 CENTRAL PARKWAY STUART, FL 34994 | CIGNA DENTAL HEALTH OF FLORIDA, INC | $1K | — | $1K | 9.00% |
| REBECCA J SMITH INC4 Filed as: REBECCA J. SMITH INC. | 2557 MICHAELSON WAY JACKSONVILLE, FL 32223 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $2K | — | $2K | 13.21% |
| KAN ENTERPRISES INC4 | 6050 GREEN POND DR JACKSONVILLE, FL 32258 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $38 | — | $38 | 0.33% |
| LIVING LEGACY BENEFITS GROUP LLC4 | 11701 PALM LAKE DR APT 122 JACKSONVILLE, FL 32218 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $33 | — | $33 | 0.29% |
| LAUREN N BARGE FOSTER4 | P.O. BOX 330383 ATLANTIC BEACH, FL 32233 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $22 | — | $22 | 0.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 NONE | Other services; Non-monetary compensation; Claims processing; Participant communication; Direct payment from the plan; Named fiduciary; Contract Administrator; Float revenue Service code 12 | — | $14K |
| CIGNA | Non-monetary compensation; Named fiduciary; Participant communication; Float revenue; Direct payment from the plan; Contract Administrator; Other services; Claims processing Service code 12 | — | $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 | 208 | 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) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 200 | $2.4M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 200 | $2.4M |
| Vision | HUMANA INSURANCE COMPANY | 142 | $22K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 0 | $0 |
| Other(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 200 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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.