| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30342 | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | $78K | $1K | $79K | 17.39% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30342 | BLUE CROSS BLUE SHIELD OF GEORGIA INC | $10K | — | $10K | 4.57% |
| PEACHTREE BENEFIT GROUP INC3 Filed as: PEACHTREE BENEFIT PARTNERS GA LLC | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30342 | BLUE CROSS BLUE SHIELD OF GEORGIA INC | $980 | — | $980 | 0.43% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30342 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA INC | $21K | — | $21K | 15.00% |
| PEACHTREE BENEFIT GROUP INC3 Filed as: PEACHTREE BENEFIT GROUP | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | AETNA LIFE INSURANCE COMPANY | $21K | — | $21K | 15.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTHCARE G EIN 58-1638390 ADMIN SVCES | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $224K |
| BLUE CROSS BLUE SHIELD HEALTHCARE | Float revenue; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $61K |
| PEACHTREE BENEFIT GROUP INC | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $28K |
| BLUE CROSS BLUE SHIELD GA INC EIN 58-0469845 NETWORK PH MGN | Other fees Service code 99 | — | $17K |
| BLUE CROSS BLUE SHIELD GA EIN 58-0469845 NETWORK PH MGN | Other fees Service code 99 | — | $13 |
| BLUE CROSS AND BLUE SHIELD GA INC EIN 58-0469845 VARI0OUS SERVICES | Other services; Other fees Service code 49 | — | $0 |
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 | 398 | 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) | 398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | 401 | $679K |
| Vision | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA INC | 341 | $138K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 432 | $134K |
| Short-term disability | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA INC | 341 | $138K |
| Long-term disability | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA INC | 341 | $138K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | 398 | $452K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 432 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.