| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 503232317 | THE HARTFORD INSURANCE COMPANY | — | $3K | $3K | 11.34% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | THE HARTFORD INSURANCE COMPANY | — | $307 | $307 | 1.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GA EIN 58-1638390 NONE | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $189K |
| ACRISURE SOUTH INSURANCE SERVICES EIN 92-3683970 NONE | Insurance brokerage commissions and fees; Consulting (general); Insurance agents and brokers Service code 16 | — | $82K |
| NAT'L EMPLOYEE BENEFITS ADMIN. INC. EIN 65-0498809 NONE | Other services; Contract Administrator; Copying and duplicating Service code 13 | — | $68K |
| DREXI, INC EIN 46-4488538 NONE | Claims processing; Contract Administrator Service code 12 | — | $59K |
| ROBEIN URANN SPENCER PICARD & CANGE EIN 72-0999672 NONE | Legal Service code 29 | — | $46K |
| PLUMBERS & PIPEFITTERS U.A. L. 188 RELATED LOCAL UNION | Other services Service code 49 | 2337 E. VICTORY DRIVE SAVANNAH, GA 31404 | $36K |
| MY BENEFITS ADMINISTRATOR LLC EIN 99-0940151 NONE | Copying and duplicating; Participant communication; Other services; Contract Administrator Service code 13 | — | $33K |
| AULT INTERNATIONAL MEDICAL MGT LLC EIN 13-4254735 NONE | Other services Service code 49 | — | $28K |
| LEGACY PROFESSIONALS, LLP EIN 32-0043599 NONE | Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 10 | — | $25K |
| TOP DRAWER INC. EIN 59-1550960 NONE | Other services Service code 49 | — | $9K |
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 | 323 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 86 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 409 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPHESYS INSURANCE COMPANY | 112 | $292K |
| Life insurance | THE HARTFORD INSURANCE COMPANY | 373 | $29K |
| Stop-loss / reinsurancereinsurance | BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY | 316 | $427K |
| Other | THE HARTFORD INSURANCE COMPANY | 373 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 373 | — |
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.