| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LISA M BLAKE3 | 627 ARBOR LAKE LANE TAMPA, FL 33602 | HARTFORD LIFE AND ACCIDENT | $5K | $0 | $5K | 8.16% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | HARTFORD LIFE AND ACCIDENT | $0 | $3K | $3K | 5.72% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 2965 ALT 19 PALM HARBOR, FL 34683 | HARTFORD LIFE AND ACCIDENT | $2K | $0 | $2K | 2.69% |
| WATER STREET BENEFITS LLC3 | 627 ARBOR LAKE LANE TAMPA, FL 33602 | TOKIO MARINE HCC | $1K | $439 | $2K | 6.80% |
| GPA3 | 12770 MERIT DRIVE DALLAS, TX 75251 | TOKIO MARINE HCC | $1K | $439 | $2K | 6.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERITAS LIFE INSURANCE CORP. EIN 47-0098400 DENTAL/VISION ADMIN | Claims processing Service code 12 | — | $23K |
| ACRISURE, LLC EIN 26-3554645 BROKER | Insurance agents and brokers Service code 22 | — | $16K |
| LISA M BLAKE BROKER | Insurance agents and brokers Service code 22 | 627 ARBOR LAKE LANE TAMPA, FL 33602 | $8K |
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 | 165 | 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) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 165 | $58K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 165 | $58K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE | 204 | $243K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 196 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.