| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 334421723 | BLUE CROSS BLUE SHIELD OF FLORIDA | $21K | — | $21K | 5.00% |
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY, INC | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 334421723 | BLUE CROSS BLUE SHIELD OF FLORIDA | $15K | — | $15K | 5.00% |
| FIDELITY INSURANCE AGENCY INC3 | 500 JIM MORAN BLVD DEERFIELD BCH, FL 334421723 | HUMANA INSURANCE COMPANY | $3K | — | $3K | 6.24% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 752511800 | HUMANA INSURANCE COMPANY | — | $552 | $552 | 1.09% |
| FIDELITY INSURANCE AGENCY INC3 | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 33442 | USABLE LIFE | $4K | — | $4K | 43.35% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 | 4800 DEERWOOD CAMPUS PKWY JACKSONVILLE, FL 32246 | USABLE LIFE | $254 | — | $254 | 2.76% |
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY, INC | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 334421723 | FLORIDA COMBINED LIFE | $1K | — | $1K | 21.49% |
| FLORIDA BLUE3 | 4800 DEERWOOD CAMPUS PKWY # DC2/2 JACKSONVILLE, FL 32246 | FLORIDA COMBINED LIFE | $169 | — | $169 | 3.41% |
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY, INC | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 334421723 | TELADOC, INC | $2K | — | $2K | 40.44% |
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY, INC | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 334421723 | FLORIDA COMBINED LIFE | $668 | — | $668 | 18.22% |
| FLORIDA BLUE3 | 4800 DEERWOOD CAMPUS PKWY # DC2/2 JACKSONVILLE, FL 32246 | FLORIDA COMBINED LIFE | $199 | — | $199 | 5.43% |
| BENEFITMALL3 | 4651 SALISBURY RD STE 483 JACKSONVILLE, FL 32256 | FLORIDA COMBINED LIFE | $27 | — | $27 | 0.74% |
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY, INC | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 334421723 | FLORIDA COMBINED LIFE | $732 | — | $732 | 25.41% |
| FLORIDA BLUE3 | 4800 DEERWOOD CAMPUS PKWY # DC2/2 JACKSONVILLE, FL 32246 | FLORIDA COMBINED LIFE | $116 | — | $116 | 4.03% |
| FIDELITY INSURANCE AGENCY INC3 | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 33442 | USABLE LIFE | $2K | — | $2K | 55.95% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 | 4800 DEERWOOD CAMPUS PKWY JACKSONVILLE, FL 32246 | USABLE LIFE | $99 | — | $99 | 3.51% |
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGCY INC | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 33442 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $220 | — | $220 | 14.99% |
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 | 109 | 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) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS BLUE SHIELD OF FLORIDA | 62 | $728K |
| Dental | HUMANA INSURANCE COMPANY | 175 | $51K |
| Vision | HUMANA INSURANCE COMPANY | 175 | $51K |
| Life insurance(2 contracts, 2 carriers) | FLORIDA COMBINED LIFE | 131 | $5K |
| Short-term disability | FLORIDA COMBINED LIFE | 29 | $3K |
| Long-term disability | FLORIDA COMBINED LIFE | 21 | $5K |
| Prescription drug(2 contracts) | BLUE CROSS BLUE SHIELD OF FLORIDA | 62 | $728K |
| Other(5 contracts, 4 carriers) | USABLE LIFE | 131 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.