| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 WEST STATE ROAD 434 LONGWOOD, FL 32750 | SUN LIFE ASSURANCE COMPANY OF CANADA | $11K | $0 | $11K | 13.41% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 WEST STATE ROAD 434 LONGWOOD, FL 32750 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $2K | $11K | 35.86% |
| WORKSITE BENEFITS SOLUTION LLC3 Filed as: WORKSITE BENEFITS SOLUTION, LLC | 2622 WYMAN CIRCLE KISSIMMEE, FL 34744 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 14.60% |
| CALVON Y BUCZKOWSKI3 Filed as: CALVON Y. BUCZKOWSKI & VARIOUS | 204 COVERED BRIDGE DRIVE OCOEE, FL 34761 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 14.33% |
| LIZBETH RAMON3 | 16128 APPENNINE DRIVE BROOKSVILLE, FL 34601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $448 | $2K | 7.42% |
| SARAH WEYMOUTH3 Filed as: SARAH WEYMOUTH, LLC | 107 OCEAN TERRACE INDIALANTIC, FL 32903 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $883 | $2K | 6.89% |
| DEBRA DAIGLE AMOEDO3 | 12750 GRECO DRIVE ORLANDO, FL 32824 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $23 | $2K | 5.05% |
| KENNETH A HOLDER3 Filed as: KENNETH A. HOLDER | 870 GREENSHANK DRIVE HAINES CITY, FL 33844 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $209 | $1K | 4.04% |
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 | 103 | 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) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $79K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $79K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $79K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 39 | $32K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 103 | — |
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.