| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITOL SPECIAL RISKS3 | 1000 PARKWOOD CIRCLE, SUITE 925 ATLANTA, GA 30339 | GREENWICH INSURANCE COMPANY | $34K | — | $34K | 9.00% |
| INTERACTIVE INSURANCE SOLUTIONS3 | 729 RAGSDALE ROAD SHARPSBURG, GA 30277 | GREENWICH INSURANCE COMPANY | $4K | — | $4K | 1.00% |
| CAPITOL SPECIAL RISKS3 | 1000 PARKWOOD CIRCLE, SUITE 925 ATLANTA, GA 30339 | GREENWICH INSURANCE COMPANY | $6K | — | $6K | 6.00% |
| INTERACTIVE INSURANCE SOLUTIONS3 | 729 RAGSDALE ROAD SHARPSBURG, GA 30277 | GREENWICH INSURANCE COMPANY | $1K | — | $1K | 1.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT PLAN ADMINISTRATION EIN 39-1400101 NONE | Direct payment from the plan; Plan Administrator Service code 14 | — | $271K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 39-1365594 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $156K |
| LEE JOST & ASSOCIATES EIN 39-1400101 NONE | Consulting (general); Actuarial; Direct payment from the plan Service code 11 | — | $45K |
| SIKICH LLP EIN 36-3168081 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $18K |
| BMO HARRIS FINANCIAL GROUP EIN 36-2085229 NONE | Investment management fees paid directly by plan; Investment management; Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $15K |
| UNITED HEALTHCARE INSURANCE COMPANY EIN 36-2739571 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $13K |
| US BANK NONE | Custodial (other than securities); Direct payment from the plan Service code 18 | P.O. BOX 1800 SAINT PAUL, MN 551010800 | $6K |
| WEX HEALTH, INC. EIN 06-1593514 NONE | Direct payment from the plan; Claims processing Service code 12 | 82 HOPMEADOW STREET, SUITE 220 SIMSBURY, CT 06089 | $6K |
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 | 392 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 112 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 504 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance(2 contracts) | GREENWICH INSURANCE COMPANY | 404 | $477K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 404 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.