| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEYSTONE BENEFIT GROUP3 | 6885 BELFORT OAKS PLACE SUITE 210 JACKSONVILLE, FL 32216 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| KEYSTONE BENEFIT GROUP3 | 6885 BELFORT OAKS PLACE SUITE 210 JACKSONVILLE, FL 32216 | DELAWARE AMERICAN LIFE INSURANCE COMPANY | $36K | — | $36K | 7.72% |
| KEYSTONE BENEFIT GROUP3 | 6885 BELFORT OAKS PLACE SUITE 210 JACKSONVILLE, FL 32216 | UNUM LIFE INSURANCE COMPANY | $0 | $8K | $8K | 2.00% |
| KEYSTONE BEN GROUP AND OTHER AGENTS3 Filed as: KEYSTONE BENEFIT GROUP (UBA OF FL) | 6885 BELFORT OAKS PLACE SUITE 210 JACKSONVILLE, FL 32216 | SUN LIFE ASSURANCE COMPANY OF CANADA | $20K | $0 | $20K | 8.16% |
| KEYSTONE BENEFIT GROUP3 | 6885 BELFORT OAKS PLACE SUITE 210 JACKSONVILLE, FL 32216 | UNUM LIFE INSURANCE COMPANY | $19K | $3K | $22K | 17.16% |
| KEYSTONE BENEFIT GROUP3 | 6885 BELFORT OAKS PLACE SUITE 210 JACKSONVILLE, FL 32216 | EYEMED VISION ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE COMPANY | $11K | — | $11K | 8.88% |
| BARRY OLFERN AND ASSOC. INC4 Filed as: BARRY OLFERN | 954 TYLER STREET HOLLYWOOD, FL 33019 | PREPAID LEGAL SERVICE INC DBA LEGALSHIELD | $3K | — | $3K | 6.00% |
| TRACY REEVES4 | 16273 SW 9TH STREET PEMBROKE PINES, FL 33027 | PREPAID LEGAL SERVICE INC DBA LEGALSHIELD | $3K | — | $3K | 6.00% |
| THOMPSON SUCCESS PARTNERS, INC.4 Filed as: THOMPSON SUCCESS PARTNERS | 2776 GEARY ST MATLACHA, FL 33993 | PREPAID LEGAL SERVICE INC DBA LEGALSHIELD | $790 | — | $790 | 1.82% |
| NEW BIZ LLC4 | 4102 COLUMNS DR. SE MARIETTA, GA 30067 | PREPAID LEGAL SERVICE INC DBA LEGALSHIELD | $541 | — | $541 | 1.25% |
| ITEM III TRUST U/W DAVID A SAVULA4 Filed as: ITEM III TRUST U/W DAVID A. SAVULA | 480 RIVERHILL DR. ATLANTA, GA 30328 | PREPAID LEGAL SERVICE INC DBA LEGALSHIELD | $256 | — | $256 | 0.59% |
| CAROL PURDY FIELDS4 Filed as: CAROL CLINTON SMITH MARITAL TRUST | 3317 WAUWINET WAY NORMAN, OK 73071 | PREPAID LEGAL SERVICE INC DBA LEGALSHIELD | $152 | — | $152 | 0.35% |
| KEYSTONE BENEFIT GROUP3 | 6885 BELFORT OAKS PLACE SUITE 210 JACKSONVILLE, FL 32216 | HARTFORD ACCIDENT AND LIFE INSURANCE COMPANY | $240 | — | $240 | 1.47% |
| KEYSTONE BENEFIT GROUP3 Filed as: KEYSTONE BENEFIT GROUP LLC | 6885 BELFORT OAKS PL STE 210 JACKSONVILLE, FL 32216 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $582 | — | $582 | 10.01% |
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 | 1,301 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 32 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,333 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 429 | $3.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 429 | $3.5M |
| Vision | EYEMED VISION ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE COMPANY | 863 | $124K |
| Life insurance(3 contracts, 2 carriers) | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 790 | $980K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY | 707 | $397K |
| Long-term disability(2 contracts, 2 carriers) | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 790 | $852K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 429 | $3.5M |
| Other(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 429 | $3.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 863 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.