| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT A LEVY3 Filed as: ROBERT MCCLEAN | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | BLUE CROSS BLUE SHIELD | $48K | $0 | $48K | 3.08% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | USABLE LIFE | $14K | $237 | $14K | 11.70% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $8K | — | $8K | 6.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROBERT MCLEAN BROKER | Insurance brokerage commissions and fees Service code 53 | 220 GALLERIA PARKWAY ATLANTA, GA 30339 | $48K |
| DIGITAL INSURANCE LLC BROKER | Insurance brokerage commissions and fees Service code 53 | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | $14K |
| MOSAIC GROUP SERVICES BROKER | Insurance brokerage commissions and fees Service code 53 | PO BOX 2291 DURHAM, NC 27702 | $8K |
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 | 225 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD | 225 | $1.6M |
| Dental | BLUE CROSS BLUE SHIELD | 225 | $1.6M |
| Vision | BLUE CROSS BLUE SHIELD | 225 | $1.6M |
| Life insurance | USABLE LIFE | 184 | $121K |
| Short-term disability | USABLE LIFE | 184 | $121K |
| Long-term disability | USABLE LIFE | 184 | $121K |
| Prescription drug | BLUE CROSS BLUE SHIELD | 225 | $1.6M |
| Other | USABLE LIFE | 184 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 225 | — |
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.