| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF FLORIDA | 7800 BELFORT PARKWAY STE 270 JACKSONVILLE, FL 32256 | FLORIDA BLUE | — | — | $0 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF FLORIDA INC | 4211 W BOY SCOUT BLVD, STE 1000 TAMPA, FL 33607 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $33K | $3K | $35K | 16.31% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF FLORIDA INC | 4211 W BOY SCOUT BLVD, STE 1000 TAMPA, FL 33607 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $23K | $2K | $25K | 16.62% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF FLORIDA INC | 4211 W BOY SCOUT BLVD, STE 1000 TAMPA, FL 33607 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $1K | $14K | 16.54% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TN DBA WILLIS OF FLORIDA | 3000 BAYPORT DR #300 TAMPA, FL 33607 | AMERICAN FIDELITY ASSURANCE COMPANY | $864 | — | $864 | 14.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF FLORIDA INC | 4211 W BOY SCOUT BLVD, STE 1000 TAMPA, FL 33607 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $792 | $83 | $875 | 16.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FLORIDA BLUE EIN 59-2015694 NONE | Claims processing Service code 12 | 4800 DEERWOOD CAMPUS PKWY JACKSONVILLE, FL 32246 | $394K |
| WILLIS OF FLORIDA EIN 62-1404453 NONE | Contract Administrator Service code 13 | 300 BAYPORT DRIVE STE 300 TAMPA, FL 33607 | $83K |
| CIGNA FMLA EIN 23-1503749 NONE | Contract Administrator Service code 13 | P.O. BOX 16163 PITTSBURGH, PA 15242 | $18K |
| ENNIS, PELLUM & ASSOCIATES, CPA'S EIN 59-1843700 NONE | Accounting (including auditing) Service code 10 | 5150 BELFORT RD, 600 JACKSONVILLE, FL 32256 | $16K |
| BLUECROSS BLUESHIELD OF SOUTH CAROL EIN 59-2015694 NONE | Claims processing Service code 12 | P.O. BOX 100237 COLUMBIA, SC 29202 | $10K |
| MEDCOM EIN 59-2316866 NONE | Legal Service code 29 | 1061 RIVERSIDE AVE. JACKSONVILLE, FL 32204 | $9K |
| AMERIFLEX EIN 27-2256926 NONE | Claims processing Service code 12 | 2508 HIGHLANDER WAY 200 CARROLLTON, TX 75006 | $5K |
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 | 788 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 792 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 462 | $152K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 474 | $217K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 474 | $86K |
| Stop-loss / reinsurancereinsurance | FLORIDA BLUE | 749 | $768K |
| Other(2 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 945 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 945 | — |
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.