| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY | MAILDROP FIADF107 500 N W 12TH AVENUE DEERFIELD BEACH, FL 334421723 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | $53K | — | $53K | 3.95% |
| DKG INSURANCE & FINANCIAL SERVICES3 Filed as: DKG INSURANCE & FINANCIAL | 12404 PARK CENTRAL DR STE 400S DALLAS, TX 75251 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | $5K | — | $5K | 0.40% |
| FIDELITY INSURANCE AGENCY INC3 | 500 JIM MORAN BLVD # 107 DEERFIELD BEACH, FL 33442 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| FIDELITY INSURANCE AGENCY INC3 | 500 JIM MORAN BLVD # 107 DEERFIELD BEACH, FL 33442 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| THE SOUTHERN REGION LLC3 | 7313 MERCHANT COURT SARASOTA, FL 34240 | AMERICAN PUBLIC LIFE INSURANCE COMPANY | $2K | — | $2K | 9.98% |
| FIDELITY INSURANCE AGENCY INC3 Filed as: FIDELITY INSURANCE AGENCY | 500 JIM MORAN BLVD FIADF107 DEERFIELD BEACH, FL 33442 | AMERICAN PUBLIC LIFE INSURANCE COMPANY | $1K | — | $1K | 7.99% |
| FIDELITY INSURANCE AGENCY INC3 | 500 JIM MORAN BLVD DEERFIELD BEACH, FL 334421723 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
No Schedule C service providers reported on this filing.
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 | 249 | 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) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 249 | $1.3M |
| Dental | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 249 | $1.3M |
| Vision | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 249 | $1.3M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 31 | $13K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $44K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 68 | $24K |
| Other(2 contracts, 2 carriers) | AMERICAN PUBLIC LIFE INSURANCE COMPANY | 35 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 249 | — |
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.