| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITOL SPECIAL RISKS3 | 1000 PARKWOOD CIR #925 ATLANTA, GA 30339 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 11.25% |
| JOHN L TODD3 | 729 RAGSDALE RD SHARPSBURG, GA 30277 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 3.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE INSURANCE COMPANY EIN 36-2739571 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $997K |
| BENEFIT PLAN ADMINISTRATION OF WI, EIN 39-1400101 NONE | Direct payment from the plan; Other services; Claims processing; Plan Administrator Service code 12 | — | $872K |
| REINHART BOERNER VAN DEUREN S.C. EIN 39-1126909 NONE | Legal; Direct payment from the plan Service code 29 | — | $119K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $95K |
| ASSOCIATED TRUST COMPANY, N.A. EIN 39-6576073 NONE | Investment management; Investment management fees paid directly by plan; Other services; Direct payment from the plan Service code 28 | — | $81K |
| LEE JOST & ASSOCIATES EIN 39-1400101 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $48K |
| JPMORGAN CHASE EIN 13-4994650 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $47K |
| AFFINITY EAP EIN 39-1127163 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $34K |
| FREYBERG HINKLE ET AL EIN 39-1531945 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $20K |
| IMAGEPLUS QUALITY PRINTING EIN 39-1738495 NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $16K |
| DELTA DENTAL EIN 39-6094742 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $16K |
| THE BOGDAHN GROUP EIN 59-3676225 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $15K |
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 | 1,632 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 379 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,011 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,872 | $33K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 1,681 | $677K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,872 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,872 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.