| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT A HEALY3 Filed as: ROBERT MORING | 12000 DELMAHOY DR CHARLOTTE, NC 28277 | BLUE CROSS BLUE SHIELD OF TENNESSEE INC | $27K | — | $27K | 2.41% |
| JOHN D OREBAUGH3 | 100 S ASHLEY DR STE 250 TAMPA, FL 33602 | BLUE CROSS BLUE SHIELD OF TENNESSEE INC | $19K | — | $19K | 1.74% |
| FIRST FLORIDA INSURANCE BROKERS3 | 100 S ASHLEY DR STE 250 TAMPA, FL 336025348 | AMERITAS LIFE INSURANCE CORPORATION | $36K | — | $36K | 10.00% |
| FIRST FLORIDA INS BROKERS LLC3 | 100 S ASHLEY DR STE 250 TAMPA, FL 336025348 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | — | $5K | 5.00% |
| FIRST FLORIDA INSURANCE BROKERS3 Filed as: FIRST FLORIDA INSURANCE BROKERS LLC | 100 S ASHLEY DR STE 250 TAMPA, FL 33602 | CIGNA | $2K | — | $2K | 4.97% |
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 | 2,584 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,587 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF TENNESSEE INC | 149 | $1.5M |
| Dental(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORPORATION | 1,826 | $395K |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 1,826 | $360K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,584 | $91K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ALABAMA | 88 | $417K |
| Other(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ALABAMA | 2,584 | $508K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,584 | — |
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.