| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NELSEN INSURANCE CONSULTING INC3 Filed as: NELSEN JR DONALD J | 1143 SHIPWATCH CIRCLE TAMPA, FL 33602 | HCC LIFE INSURANCE COMPANY | $20K | — | $20K | 7.50% |
| NELSEN INSURANCE CONSULTING INC3 | 1143 SHIPWATCH CIRCLE TAMPA, FL 33602 | HCC LIFE INSURANCE COMPANY | $3K | — | $3K | 1.23% |
| DONALD J NELSON JR3 Filed as: DONALD J NELSON | 1143 SHIPWATCH CIR TAMPA, FL 336025786 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 13.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL EMPLOYEE BENEFITS ADMINIST EIN 65-0498809 NONE | Contract Administrator Service code 13 | 2010 NW 1050TH AVE PEMBROKE PINES, FL 33028 | $60K |
| KARPUS INVESTMENT MANAGEMENT INC EIN 16-1290558 NONE | Investment management Service code 28 | 183 SULLYS TRAIL PITTSFORD, NY 14534 | $45K |
| WITHERS BENEFITS CONSULTANTS INC EIN 59-3309390 NONE | Consulting (general) Service code 16 | P O BOX 9 SAN ANTONIO, FL 33576 | $24K |
| BMJ CPA PLC EIN 45-3414091 NONE | Accounting (including auditing) Service code 10 | 1326 S RIDGEWOOD AVE STE 18 DAYTONA BEACH, FL 321146190 | $15K |
| PENSION FUND EVALUATIONS INC EIN 11-2503982 NONE | Investment advisory (plan) Service code 27 | 2450 MIDDLE COUNTRY ROAD CENTEREACH, NY 11720 | $7K |
| LAW OFFICE OF THOMAS JOHNSON EIN 59-3519587 NONE | Legal Service code 29 | 510 VANDERBURG DR STE 309 BRANDON, FL 33511 | $3K |
| PNC BANK NA EIN 25-1211909 NONE | Custodial (securities) Service code 19 | 1900 E PTH STREET 13TH FLOOR MAIL STOP B7-YB13-15-4 CLEVELAND, OH 44114 | $1K |
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 | 195 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 232 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 234 | $9K |
| Vision | VISION SERVICE PLAN | 234 | $24K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 236 | $30K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 226 | $266K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 236 | — |
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.