| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF FLORIDA INC | 1421 PINE RIDGE RD SUITE 200 NAPLES, FL 341092116 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $3K | $10K | 7.59% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA | 11220 ASSETT LOOP SUITE 304 MANASSAS, VA 20109 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $814 | $814 | 0.60% |
| JERRY F NICHOLS3 | 1421 PINE RIDGE RD SUITE 228 NAPLES, FL 34109 | NORTHWESTERN MUTUAL | $4K | $1K | $5K | 9.18% |
| ASSUREDPARTNERS3 Filed as: SOUTH FLORIDA GRP LLC | 500 E BROWARD BLVD STE 2000 FORT LAUDERDALE, FL 33394 | NORTHWESTERN MUTUAL | $760 | $67 | $827 | 1.45% |
| JOHN C RASCHELLA3 Filed as: JOHN R DELANEY | 23160 FASHION DR STE 217 ESTERO, FL 33928 | NORTHWESTERN MUTUAL | $373 | $88 | $461 | 0.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERICAN SPECIALTY HEALTH | Direct payment from the plan; Float revenue; Other services; Contract Administrator; Participant communication; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | 10221 WATERIDGE CIRCLE SUITE 201 SAN DIEGO, CA 92121 | $0 |
| CARECORE D/B/A EVICORE | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | 400 BUCKWALTER PLACE BLVD BLUFFON, SC 29910 | $0 |
| MEDSOLUTIONS D/B/A EVICORE, INC. | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | 730 COOL SPRINGS BLVD SUITE 800 FRANKLIN, TN 37067 | $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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | 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) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION INC. | 19 | $87K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 121 | $136K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 121 | $136K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 121 | $136K |
| Long-term disability | NORTHWESTERN MUTUAL | 0 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 121 | — |
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.