| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DR SE SUITE 300 ATLANTA, GA 30339 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $5K | — | $5K | 0.39% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES LLC | P O BOX 896620 CHARLOTTE, NC 28289 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | — | $3K | 0.20% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 15.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 15.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC GA | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | EYEMED VISION CARE | $1K | — | $1K | 9.98% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $498 | — | $498 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Plan Administrator; Claims processing Service code 12 | — | $77K |
| MCGRIFF SEIBELS AND WILLIAMS BROKER | Insurance services; Insurance agents and brokers Service code 22 | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | $77K |
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 | 185 | 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) | 185 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 195 | $1.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 195 | $1.3M |
| Vision | EYEMED VISION CARE | 185 | $10K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 452 | $25K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 185 | $42K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 36 | $20K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 452 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 452 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.