| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 201 ALHAMBRA CIRCLE, SUITE 801 CORAL GABLES, FL 33134 | BLUE CROSS BLUE SHIELD OF FLORIDA | $95K | $0 | $95K | 4.00% |
| USI INSURANCE SERVICES LLC3 | 201 ALHAMBRA CIRCLE, SUITE 801 CORAL GABLES, FL 33134 | HEALTH OPTIONS, INC. | $29K | $0 | $29K | 4.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $42K | $17K | $59K | 21.21% |
| USI INSURANCE SERVICES LLC3 | 1 CONCOURSE CENTER PARKWAY SUITE 700 ATLANTA, GA 30328 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 9.99% |
| UNKNOWN3 | UNKNOWN MIRAMAR, FL 33025 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $8K | $8K | 3.58% |
| USI INSURANCE SERVICES LLC3 | 1575 NORTHSIDE DRIVE ATLANTA, GA 30318 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $950 | $14 | $964 | 5.79% |
| INSGROUP INC3 Filed as: ESQUEN INSURANCE GROUP CORPORATION | 14552 SW 152ND PLACE MIAMI, FL 33196 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $327 | $0 | $327 | 1.96% |
| SHEALY BENEFITS SERVICES INC3 Filed as: SHEALY BENEFITS SERVICES, INC. | 215 HOGAN WAY LEXINGTON, SC 29072 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $299 | $0 | $299 | 1.80% |
| MONICA MARIA REVUELTA3 Filed as: MONICA M. REVUELTA AND OTHER AGENTS | 4721 NW 178TH TERRACE MIAMI GARDENS, FL 33055 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $234 | $25 | $259 | 1.56% |
| YESENIA HENOHE OSORIO3 | 13611 ISHNALA CIRCLE WILLINGTON, FL 33414 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $146 | $25 | $171 | 1.03% |
| JUAN PABLO CONTESSE3 | 12120 SW 106TH STREET MIAMI, FL 33186 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $82 | $0 | $82 | 0.49% |
| GINA MARIE MARTINEZ3 | 2400 NE 36TH STREET, APARTMENT 7 LIGHTHOUSE POINT, FL 33064 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $0 | $60 | 0.36% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF FLORIDA | 249 | $3.1M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 344 | $229K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 344 | $229K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 726 | $279K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 726 | $279K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 726 | $279K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF FLORIDA | 249 | $3.1M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 726 | $295K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 726 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.