| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | BLUE CROSS BLUE SHIELD OF FLORIDA | $33K | $0 | $33K | 3.00% |
| PAYCHEX INSURANCE AGENCY, INC.3 | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. | $13K | $0 | $13K | 7.92% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 12940 SW 133RD COURT MIAMI, FL 33186 | FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. | $4K | $0 | $4K | 2.51% |
| PAYCHEX INSURANCE AGENCY, INC.3 | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $378 | $0 | $378 | 2.60% |
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 | 147 | 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) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF FLORIDA | 137 | $1.1M |
| Dental | FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. | 148 | $169K |
| Life insurance(2 contracts, 2 carriers) | FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. | 148 | $187K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 38 | $15K |
| Long-term disability | FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. | 148 | $169K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF FLORIDA | 137 | $1.1M |
| Other(3 contracts, 3 carriers) | FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. | 148 | $202K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.