| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 3475 PIEDMONT ROAD NE SUITE 800 ATLANTA, GA 30305 | SYMETRA LIFE INSURANCE COMPANY | — | $6K | $6K | 3.35% |
| WELLS FARGO INSURANCE SERVICES3 | 3475 PIEDMONT ROAD NE SUITE 800 ATLANTA, GA 30305 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $8K | — | $8K | 15.81% |
| WELLS FARGO INSURANCE SERVICES3 | P O BOX 201503 GEORGIA LOCKBOX DALLS, TX 75320 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $48 | $48 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GEORGIA EIN 58-0469845 ADMINISTRATOR | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing; Other fees Service code 12 | — | $398K |
| BLUE CROSS AND BLUE SHIELD OF GA | Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $154K |
| WELLS FARGO INS SERVICES USA | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $92K |
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 | 382 | 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) | 382 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 348 | $198K |
| Long-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 348 | $221K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 382 | $176K |
| Other(3 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 348 | $198K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 382 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.