| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 220 WALNUT PLAZA MUNCIE, IN 47305 | BLUE CROSS AND BLUE SHIELD HEALTHCARE PLAN GA | $70K | $540 | $71K | 15.22% |
| ACRISURE LLC3 | 220 WALNUT PLAZA MUNCIE, IN 47305 | GREATER GEORGIA LIFE INSURANCE COMPANY | $39K | — | $39K | 13.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HLTH PL GA EIN 58-1638390 CLAIMS ADMIN | Other fees; Float revenue; Foreign entity (e.g., an agent or broker, bank, insurance company, etc. not operating within jurisdictional boundaries of the United States); Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $261K |
| ACRISURE LLC | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | — | $70K |
| INGENIORX INC | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $56K |
| BLUE CROSS BLUE SHIELD HEALTH PL GA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue; Contract Administrator Service code 12 | — | $48K |
| BLUE CROSS AND BLUE SHIELD OF GEORG EIN 58-0469845 CLAIMS ADMIN | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services Service code 12 | — | $4K |
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 | 350 | 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) | 350 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | BLUE CROSS AND BLUE SHIELD HEALTHCARE PLAN GA | 583 | $463K |
| Life insurance | GREATER GEORGIA LIFE INSURANCE COMPANY | 350 | $285K |
| Short-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 350 | $285K |
| Long-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 350 | $285K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD HEALTHCARE PLAN GA | 583 | $463K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 583 | — |
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.