| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | GREATER GEORGIA LIFE INSURANCE COMPANY | $9K | $2K | $11K | 17.93% |
| ACRISURE LLC3 | 16805 W CLEVELAND AVENUE NEW BERLIN, WI 53151 | BLUE CROSS AND BLUE SHIELD OF GEORGIA | $1K | $72 | $1K | 10.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF GA EIN 58-1638390 ADMIN SERVICES | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $232K |
| ACRISURE LLC | Other commissions; Non-monetary compensation; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $54K |
| INGENIORX EIN 82-3062245 PRESCRIP DRUG REBATES | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services Service code 12 | — | -$35K |
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 | 170 | 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) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 254 | $236K |
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA | 214 | $14K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA | 214 | $14K |
| Life insurance | GREATER GEORGIA LIFE INSURANCE COMPANY | 170 | $61K |
| Long-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 170 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 254 | — |
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."
No prospect flags tripped on this filing.