| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LASSITER WARE3 Filed as: LASSITER WARE INC | 1317 CITIZENS BOULEVARD LEESBURG, FL 34748 | HCC LIFE INSURANCE COMPANY | $21K | — | $21K | 7.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Contract Administrator; Named fiduciary; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | — | $116K |
| NATIONAL EMPLOYEE BENEFITS ADMINIST EIN 65-0498809 NONE | Contract Administrator Service code 13 | — | $69K |
| LASSITER WARE EIN 59-1258855 NONE | Consulting (general) Service code 16 | — | $56K |
| LAW OFFICE OF THOMAS JOHNSON, P.A. EIN 59-3519587 NONE | Legal Service code 29 | — | $41K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $19K |
| BHA CONSULTING LLC EIN 26-1384808 NONE | Consulting (general) Service code 16 | — | $14K |
| CATAMARAN EIN 11-2581812 NONE | Contract Administrator Service code 13 | — | $8K |
| SUNTRUST BANK NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | 770 LANE AVENUE JACKSONVILLE, FL 32205 | $5K |
| SOUTHERN ACTUARIAL SERVICES CO. INC EIN 58-2409046 NONE | Actuarial Service code 11 | — | $5K |
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 | 280 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 317 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 294 | $274K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 294 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.