| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE BENEFIT COMPANY INC3 Filed as: THE BENEFIT COMPANY | SIX CONCOURSE PARKWAY SUITE 2750 ATLANTA, GA 30328 | STANDARD SECURITY LIFE INSURANCE | $48K | — | $48K | 14.00% |
| SEE ATTACHMENT3 | — | COLONIAL LIFE & ACCIDENT INS CO | $81K | $15K | $96K | 28.88% |
| THE BENEFIT COMPANY INC3 Filed as: THE BENEFIT COMPANY | SIX CONCOURSE PARKWAY SUITE 2750 ATLANTA, GA 30328 | HARTFORD LIFE AND ACCIDENT | $63K | — | $63K | 20.36% |
| THE BENEFIT COMPANY INC3 Filed as: THE BENEFIT COMPANY | SIX CONCOURSE PARKWAY SUITE 2750 ATLANTA, GA 30328 | NATIONAL VISION ADMINISTRATORS - FSL | $2K | — | $2K | 5.00% |
| INTEGRO INSURANCE BROKERS3 Filed as: INTEGRO USA INC | 3500 LENOX RD STE 1600 ATLANTA, GA 30326 | COLONIAL LIFE & ACCIDENT INS CO | $48 | — | $48 | 2.26% |
| DOMINIUM BENEFITS, LLC3 | 3500 LENOX RD STE 1600 ATLANTA, GA 30326 | COLONIAL LIFE & ACCIDENT INS CO | $30 | — | $30 | 1.41% |
| SANTE CONCEPTS INC3 | DBA SANTE CONCEPTS INC ATLANTA, GA 31139 | COLONIAL LIFE & ACCIDENT INS CO | $25 | — | $25 | 1.18% |
| LAURIE J BURNS3 | 303 PLYLER RD INDIAN TRAIL, NC 28079 | COLONIAL LIFE & ACCIDENT INS CO | $23 | — | $23 | 1.08% |
| LESLIE BUSSEY3 | PO BOX 725385 ATLANTA, GA 31139 | COLONIAL LIFE & ACCIDENT INS CO | $15 | — | $15 | 0.71% |
| KLINGBEIL AND ASSOCIATES INC3 Filed as: KLINGBEIL AND ASSOCIATES INC. | 6000 LAKE FORREST DRIVE ATLANTA, GA 30328 | COLONIAL LIFE & ACCIDENT INS CO | $15 | — | $15 | 0.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT ADMINISTRATIVE SYSTEMS, LLC EIN 36-4197088 THIRD PARTY ADMINISTRATOR | Other services; Plan Administrator; Claims processing Service code 12 | — | $106K |
| THE BENEFIT COMPANY CONSULTANT | Consulting (general) Service code 16 | SIX CONCOURSE PARKWAY SUITE 2750 ATLANTA, GA 30328 | $104K |
| CIGNA EIN 84-0467907 NETWORK PROVIDER | Other services Service code 49 | — | $74K |
| TELADOC, INC EIN 04-3705970 TELEHEALTH CARE PROVIDER | Other services Service code 49 | — | $9K |
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 | 573 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 576 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL VISION ADMINISTRATORS - FSL | 291 | $48K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 575 | $309K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 575 | $309K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 575 | $309K |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE INSURANCE | 344 | $339K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INS CO | 575 | $643K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 575 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.