| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 1560 ORANGE AVE SUITE 750 WINTER PARK, FL 327895552 | HEALTH OPTIONS INC | $34K | — | $34K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 1560 ORANGE AVE SUITE 750 WINTER PARK, FL 327895552 | BLUE CROSS BLUE SHIELD OF FLORIDA | $9K | — | $9K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL FLORIDA | 1330 LADY STREET SUITE 202 COLUMBIA, SC 29201 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 9.59% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS- SEE ATTACHED LIST | PO BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8K | $585 | $9K | 21.15% |
| DREW E SAMELSON3 | 346 TRISMEN TERRACE WINTER PARK, FL 32789 | THE HARTFORD | $4K | — | $4K | 10.00% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS- SEE ATTACHED LIST | PO BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $93 | $2K | 15.99% |
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 | 128 | 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) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH OPTIONS INC | 91 | $711K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 128 | $54K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 128 | $54K |
| Long-term disability | THE HARTFORD | 100 | $37K |
| Other(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 128 | $107K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.