| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $77K | — | $77K | 17.90% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $103 | $103 | 0.02% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | HARTFORD LIFE AND ACCIDENT | $37K | — | $37K | 15.00% |
| MCGRIFF INSURANCE SERVICES INC3 | 414 GALLIMORE DAIRY ROAD #F GREENSBORO, NC 27409 | HARTFORD LIFE AND ACCIDENT | — | $5K | $5K | 1.99% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | METROPOLITAN LIFE INSURANCE COMPANY | — | $20 | $20 | 0.01% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | HARTFORD LIFE AND ACCIDENT | $21K | — | $21K | 22.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARM BENE MGMT | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $606K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $173K |
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 | 290 | 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) | 290 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 517 | $201K |
| Vision | EYEMED VISION CARE | 333 | $20K |
| Life insurance(3 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 290 | $773K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 290 | $429K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 225 | $367K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 290 | $429K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 517 | — |
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.