| 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% |
| AON CONSULTING INC3 Filed as: AON CONSULTING INC. | 29840 NETWORK PLACE CHICAGO, IL 606731298 | HCC LIFE INSURANCE COMPANY | — | $3K | $3K | 2.00% |
| PATTERSON DANIEL HAMMOND3 Filed as: PATTERSON, DANIEL, HAMMOND | 2703 E. LAKE RD. MCDONOUGH, GA 30252 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 1.60% |
| JOHNSON, ANDERSON, SIDNEY3 | PO BOX 5306 ATHENS, GA 30604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $609 | — | $609 | 0.75% |
| DANIEL H. PATTERSON3 Filed as: DANIEL HAMMOND PATTERSON | 2703 E LAKE ROAD MCDONOUGH, GA 30252 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 9.66% |
| BENEFITSTORE INC3 | DALLAS LOCKBOX NUMBER 893383 14501 NORTH PLANO RD, SUITE 100 RICHARDSON, TX 75081 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $105 | — | $105 | 0.15% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CVS PHARMACY, INC. EIN 05-0340626 CLAIMS PROCESSOR | Claims processing; Direct payment from the plan Service code 12 | — | $3.6M |
| BLUE SHIELD HEALTHCARE PLAN OF GA EIN 58-1638390 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $484K |
| BLUE CROSS AND BLUE SHIELD GEORGIA EIN 58-0469845 CONTRACT ADMINISTRATOR | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $382K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CLAIMS ADMINISTRATOR | Claims processing; Direct payment from the plan Service code 12 | — | $40K |
| LINCOLN NATIONAL LIFE INSURANCE CO. EIN 35-0472300 CLAIMS ADMINISTRATION | Claims processing; Direct payment from the plan Service code 12 | — | $15K |
| WEX EIN 06-1593514 NONE | Claims processing; Contract Administrator Service code 12 | — | $14K |
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 | 903 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 910 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision(3 contracts) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,123 | $64K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,490 | $579K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 163 | $36K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 703 | $199K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 780 | $133K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,490 | $567K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,490 | — |
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.