| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 16805 W CLEVELAND AVE NEW BERLIN, WI 53151 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | — | $277 | $277 | 0.05% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | $3K | $19K | 10.79% |
| ACRISURE LLC3 | 330 SUPERIOR MALL PORT HURON, MI 48060 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | — | $10K | 5.69% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $1K | $10K | 12.04% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE NE SUITE 100 CHAMBLEE, GA 30341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $1K | $9K | 11.26% |
| ACRISURE LLC3 | 330 SUPERIOR MALL PORT HURON, MI 48060 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 5.44% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $1 | $2K | 10.19% |
| ACRISURE LLC3 | 330 SUPERIOR MALL PORT HURON, MI 48060 | MUTUAL OF OMAHA INSURANCE COMPANY | $756 | — | $756 | 4.82% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 98.41% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE NE SUITE 100 CHAMBLEE, GA 30341 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $98 | $98 | 1.59% |
| ASSUREDPARTNERS3 Filed as: STERLING SEACREST PARTNERS INC | P O BOX 724137 ATLANTA, GA 31139 | METROPOLITAN LIFE INSURANCE COMPANY | — | $46 | $46 | — |
| ASSUREDPARTNERS3 Filed as: STERLING SEACREST PARTNERS INC | P O BOX 724137 ATLANTA, GA 31139 | METROPOLITAN LIFE INSURANCE COMPANY | — | — | $0 | — |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE NE SUITE 100 CHAMBLEE, GA 30341 | METROPOLITAN LIFE INSURANCE COMPANY | -$161 | — | -$161 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTH PL GA EIN 58-1638390 NETWORK PHARM MARGIN | Other services; Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $387K |
| ACRISURE LLC | Insurance agents and brokers; Non-monetary compensation; Other commissions Service code 22 | — | $183K |
| INGENIORX EIN 82-3062245 PRESCRIP DRUG ADMIN | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $8K |
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 | 310 | 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) | 310 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $0 |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 310 | $254K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 310 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 300 | $82K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 728 | $548K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 310 | $270K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 728 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.