| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 | 29840 NETWORK PLACE CHICAGO, IL 606731298 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 1.58% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 29840 NETWORK PLACE CHICAGO, IL 60673 | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | — | $1K | $1K | 0.41% |
| PATTERSON DANIEL HAMMOND3 Filed as: PATTERSON, DANIEL, HAMMOND | 2703 E. LAKE RD. MCDONOUGH, GA 30252 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $17K | — | $17K | 7.17% |
| JOHNSON, ANDERSON, SIDNEY3 | PO BOX 6828 ATHENS, GA 30604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 0.76% |
| DANIEL H. PATTERSON3 Filed as: DANIEL HAMMOND PATTERSON | 2703 E LAKE ROAD MCDONOUGH, GA 30252 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 4.57% |
| BENEFITSTORE INC3 | DALLAS LOCKBOX NUMBER 893383 14501 NORTH PLANO RD, SUITE 100 RICHARDSON, TX 75081 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $44 | $3K | 2.53% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | 29840 NETWORK PLACE CHICAGO, IL 60683 | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | — | $160 | $160 | 0.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE SHIELD HEALTHCARE PLAN OF GA EIN 58-1638390 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.1M |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CLAIMS ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $70K |
| LINCOLN LIFE ASSURANCE OF BOSTON EIN 04-6076039 CLAIMS ADMINISTRATION | Direct payment from the plan; Claims processing Service code 12 | — | $39K |
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 | 1,097 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision(4 contracts) | EYEMED VISION CARE | 2,093 | $128K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 2,790 | $1.0M |
| Short-term disability | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 155 | $37K |
| Long-term disability | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 1,338 | $340K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 2,790 | $903K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,790 | — |
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.