| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 | 29840 NETWORK PLACE CHICAGO, IL 606731298 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 1.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVC WEST | PO BOX 101162 PASADENA, CA 911890001 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 1.55% |
| AON CONSULTING INC3 Filed as: AON CONSULTING INC. | 29840 NETWORK PLACE CHICAGO, IL 606731298 | HCC LIFE INSURANCE COMPANY | — | $2K | $2K | 2.00% |
| PATTERSON DANIEL HAMMOND3 Filed as: PATTERSON, DANIEL, HAMMOND | 2703 E. LAKE RD. MCDONOUGH, GA 30252 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 1.62% |
| JOHNSON, ANDERSON, SIDNEY3 | PO BOX 5306 ATHENS, GA 30604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $724 | — | $724 | 0.71% |
| DANIEL H. PATTERSON3 Filed as: DANIEL HAMMOND PATTERSON | 2703 E LAKE ROAD MCDONOUGH, GA 30252 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 6.59% |
| BENEFITSTORE INC3 | DALLAS LOCKBOX NUMBER 893383 14501 NORTH PLANO RD, SUITE 100 RICHARDSON, TX 75081 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $139 | — | $139 | 0.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CVS PHARMACY, INC. EIN 05-0340626 CLAIMS PROCESSOR | Direct payment from the plan; Claims processing Service code 12 | — | $3.1M |
| BLUE SHIELD HEALTHCARE PLAN OF GA EIN 58-1638390 CONTRACT ADMINISTRATOR | Float revenue; Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $507K |
| BLUE CROSS AND BLUE SHIELD GEORGIA EIN 58-0469845 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $44K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CLAIMS ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $40K |
| LINCOLN NATIONAL LIFE INSURANCE CO. EIN 35-0472300 CLAIMS ADMINISTRATION | Claims processing; Direct payment from the plan Service code 12 | — | $13K |
| WEX EIN 06-1593514 NONE | Contract Administrator; Claims processing Service code 12 | — | $2K |
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 | 913 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 913 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision(4 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,172 | $73K |
| Life insurance(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,509 | $965K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 124 | $32K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 680 | $161K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 825 | $123K |
| Other(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,509 | $928K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,509 | — |
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."
No prospect flags tripped on this filing.