| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA | 1855 W STATE RD 434 LONGWOOD, FL 32750 | BLUE CROSS BLUE SHIELD OF FLORIDA | $90K | — | $90K | 5.00% |
| INSURANCE OFFICE OF AMERICA | 1855 W STATE RD 434 SUITE 250 LONGWOOD, FL 32750 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $44K | $10K | $53K | 10.37% |
| INSURANCE OFFICE OF AMERICA Filed as: INSURANCE OFFICE OF AMERICA INC | 1855 W STATE RD 434 LONGWOOD, FL 32750 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23K | $5K | $28K | 33.79% |
| WORKSITE BENEFITS SOLUTION LLC | 323 PLEASANT ST KISSIMMEE, FL 34741 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $5K | $14K | 16.76% |
| CALVON Y BUCZKOWSKI Filed as: CALVON BUCZKOWSKI | 2608 TALL MAPLE LOOP OCOEE, FL 34761 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $4K | $6K | 6.72% |
| OMAR ENRIQUE FIGUEROA | 2862 GRASMERE VIEW PKWY KISSIMMEE, FL 34746 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $210 | $5K | 5.94% |
| SARAH WEYMOUTH | 306 MAPLE AVE KISSIMMEE, FL 34741 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $1K | $5K | 5.84% |
| WINFREDA HELEN LUTZ | 16658 HAMILTON DR ORLANDO, FL 32833 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $247 | $3K | 3.78% |
| JENNIFER WEYMOUTH RESMONDO Filed as: JENNIFER WEYMOUTH EVANS | 2940 OAKTREE DR KISSIMMEE, FL 34744 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $459 | $2K | 2.08% |
| DEANNA BOUFFORD | 323 PLEASANT ST KISSIMMEE, FL 34741 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $142 | $1K | 1.67% |
| ROBERT SHAVERS | 1537 COLONY AVE KISSIMMEE, FL 34744 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $964 | $30 | $994 | 1.21% |
| CARUSO INSURANCE BENEFITS INC | 10872 WILDERNESS CT ORLANDO, FL 32821 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $773 | $78 | $851 | 1.03% |
| CHRISTINE LYNN MORGESTER | 9405 NE 100TH WAY VANCOUVER, WA 98662 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $557 | $126 | $683 | 0.83% |
| ROXANA BUSCHMAN | 400 NORTHEAST 149TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $529 | $80 | $609 | 0.74% |
| DEREK THURSTON | 112 NW 114TH ST VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $376 | $11 | $387 | 0.47% |
| PREMIER WORKSITE SOLUTIONS INC | 806 NW 79TH ST VANCOUVER, WA 98665 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $152 | $199 | $351 | 0.43% |
| PAULA LEE BELLEY Filed as: PAULA BELLEY | 4317 LONGSHORE DR LAND O LAKES, FL 34639 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $310 | $3 | $313 | 0.38% |
| NICHOLAS HALSTON GIROD | 8520 VALENCIA VILLAGE LN ORLANDO, FL 32825 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $143 | $17 | $160 | 0.19% |
| KENNETH A HOLDER Filed as: KENNETH HOLDER | 638 LAKEHAVEN CIRCLE ORLANDO, FL 32828 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $126 | $33 | $159 | 0.19% |
| BENEFITS BY DESIGN INC | 2101 NE 279TH ST VANCOUVER, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | $55 | $142 | 0.17% |
| RENEE SESSIONS WILLIAMS | 1310 HIGHLAND CIR KISSIMMEE, FL 34744 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $139 | — | $139 | 0.17% |
| KARINA IBANEZ | 8520 VALENCIA VILLAGE LN #203 ORLANDO, FL 32825 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $130 | $8 | $138 | 0.17% |
| MARYLINE Z ORELLANA | 2949 CLIPPER COVE LANE KISSIMMEE, FL 34741 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $22 | $28 | 0.03% |
| MICHAEL A DUARTE Filed as: MICHAEL DUARTE | 515 DULL STREET DICKSON, TN 37055 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| INSURANCE OFFICE OF AMERICA | 1855 W STATE RD 434 LONGWOOD, FL 32750 | FIDELITY SECURITY LIFE INSURANCE COMPANY - EYEMED | $2K | — | $2K | 10.07% |
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 | 505 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 507 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF FLORIDA | 292 | $1.8M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $516K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY - EYEMED | 430 | $22K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 325 | $598K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $516K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $516K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 325 | $598K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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.