| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | $1K | — | $1K | 0.61% |
| PEACHTREE BENEFIT GROUP INC3 Filed as: PEACHTREE BENEFIT PARTNERS OF GEORG | 3580 PIERCE DRIVE SUITE 100 ATLANTA, GA 30341 | GREATER GEORGIA LIFE INSURANCE COMPANY | $7K | — | $7K | 7.57% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | GREATER GEORGIA LIFE INSURANCE COMPANY | $5K | — | $5K | 5.02% |
| ACRISURE LLC3 | 220 WALNUT PLAZA MUNCIE, IN 47305 | GREATER GEORGIA LIFE INSURANCE COMPANY | $1K | $445 | $2K | 1.71% |
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | BLUE CROSS AND BLUE SHIELD OF GEORGIA | $1K | — | $1K | 8.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF GA EIN 58-0469845 ADMIN SERVICES | Contract Administrator; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $148K |
| BLUE CROSS BLUE SHIELD HEALTHCARE G | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $75K |
| ACRISURE LLC | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $63K |
| BLUE CROSS BLUE SHIELD HEALTH PL GA EIN 58-1638390 ADMIN SERVICES | Other services; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $10K |
| BLUE CROSS BLUE SHIELD HEALTH GA EIN 58-1638390 NETW PHR MGN | Product termination fees (surrender charges, etc.) Service code 58 | — | $58 |
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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 327 | $244K |
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA | 251 | $18K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA | 251 | $18K |
| Life insurance | GREATER GEORGIA LIFE INSURANCE COMPANY | 193 | $93K |
| Long-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 193 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 327 | — |
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.