Form 5500 · Employee benefit plan · JACKSONVILLE, FL
FLORIDA CAPITAL BANK, N.A.
The filing calls this plan FLORIDA CAPITAL BANK, N.A. FLORIDA CAPITAL BANK NA WELFARE BENEFIT PLAN.
FLORIDA CAPITAL BANK, N.A. of JACKSONVILLE, FL insures health, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is BALDWIN KRYSTYN SHERMAN PARTNERS. Coverage is written through BLUE CROSS BLUE SHIELD OF FLORIDA and 2 other carriers. The plan's most recent policy period ended in February.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 59-2475686 · plan 508 · plan year 2024, filed Aug 29, 2024
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Life: USABLE LIFE covers 1 of 128 participants (0.8%) on Schedule A.
Disability: the largest of the 2 insured disability contracts, with USABLE LIFE, covers 1 of 128 participants (0.8%) on Schedule A.
2 contracts on this filing do not say which benefits they cover, so a line above may be insured by one of them.
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 7 insured contracts covering health, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD OF FLORIDA, covers 72 people.
The filing declares health, vision, life, disability and dental. Dental appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on one of the 2 contracts here that do not say what they cover.
Reported premium across the insured contracts is $1,265,844, with $74,925 in disclosed broker commissions — about 5.9% of premium.
The most recent policy period ended in February, and the plan year ends February 29. Group contracts typically renew on that annual cycle.
BALDWIN KRYSTYN SHERMAN PARTNERS is the broker of record on all 7 contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA | Health | 72 | Mar 1, 2024 | $1,147,794 | $45,912 |
| USABLE LIFE | — | 52 | Mar 1, 2024 | $41,936 | $10,937 |
| USABLE LIFE | Disability | 1 | Mar 1, 2024 | $27,863 | $7,426 |
| USABLE LIFE | Disability | 1 | Mar 1, 2024 | $18,716 | $4,942 |
| USABLE LIFE | Life | 1 | Mar 1, 2024 | $14,950 | $3,952 |
| HUMANA INSURANCE COMPANY | Vision | 84 | Mar 1, 2024 | $12,644 | $1,251 |
| USABLE LIFE | — | 52 | Mar 1, 2024 | $1,941 | $505 |
Premium and claims on this contract
BLUE CROSS BLUE SHIELD OF FLORIDA, contract B9472. For the contract year on this filing, the carrier reported $1,147,794 in premium earned and $918,350 in claims incurred. Dividing one by the other gives 80%.
- BLUE CROSS BLUE SHIELD OF FLORIDA, contract B9472 reported $229,444 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Other plans filed by this employer
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