| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 ALPHARETTA, GA 30022 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | $43K | — | $43K | 11.10% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 APPLE CENTRAL LLC, GA 30022 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 10.00% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 ALPHARETTA, GA 30022 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 10.00% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 APPLE CENTRAL LLC, GA 30022 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 10.00% |
| RELATION INSURANCE INC | 5825 MEDLOCK BRIDGE PKWY SUITE 200 ALPHARETTA, GA 30022 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE ROAD SUITE 200 APPLE CENTRAL LLC, GA 30022 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $166 | — | $166 | 10.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS EIN 36-3086057 TPA | Contract Administrator; Plan Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $290K |
| RELATION INSURANCE EIN 26-0291031 BROKER | Insurance agents and brokers; Insurance services Service code 22 | — | $167K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 PPO | Claims processing; Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $118K |
| EVERNORTH BEHAVIORAL HEALTH INC EIN 41-1648670 CLAIMS PROCESSING | Participant communication; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $47K |
| AMINO INC OTHER | Consulting (general) Service code 16 | 25 TAYLOR STREET SUITE 208 SAN FRANCISCO, CA 94102 | $15K |
| TELADOC EIN 35-2351217 TELEMEDICINE | Insurance services Service code 23 | — | $10K |
| MARQUEE HEALTH LLC WELLNESS | Insurance agents and brokers; Insurance services Service code 22 | 223 W ERIE STREET #7 SW CHICAGO, IL 60654 | $9K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 UTILIZATION REVIEW | Plan Administrator; Contract Administrator Service code 13 | — | $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 | 667 | 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) | 667 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 480 | $4K |
| Dental | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 1,046 | $384K |
| Vision | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 1,046 | $384K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 667 | $94K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 667 | $98K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 667 | $93K |
| Stop-loss / reinsurancereinsurance | NORTH AMERICAN SPECIALTY INSURANCE COMPANY | 607 | $985K |
| Other(4 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 667 | $287K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,046 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.