| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS AND BLUE SHIELD HEALTHCARE PLAN GA | $546 | $703 | $1K | 0.22% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | GREATER GEORGIA LIFE INSURANCE COMPANY | $39K | $1K | $40K | 24.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HLTH PL GA EIN 58-1638390 CLAIMS ADMIN | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Foreign entity (e.g., an agent or broker, bank, insurance company, etc. not operating within jurisdictional boundaries of the United States); Claims processing Service code 12 | — | $292K |
| BLUE CROSS BLUE SHIELD HEALTH PL GA | Claims processing; Insurance brokerage commissions and fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance agents and brokers; Float revenue; Other commissions; Contract Administrator Service code 12 | — | $199K |
| ANTHEM INSURANCE COMPANIES INC EIN 35-0781558 CLAIMS ADMIN | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $45K |
| INGENIORX EIN 82-3062245 PRESCRIP ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue Service code 12 | — | -$73K |
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 | 331 | 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) | 331 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GREATER GEORGIA LIFE INSURANCE COMPANY | 331 | $168K |
| Short-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 331 | $168K |
| Long-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 331 | $168K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD HEALTHCARE PLAN GA | 1,377 | $579K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,377 | — |
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.