| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF GA | 5 CONCOURSE PARKWAY SUITE 1800 ATLANTA, GA 30328 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AFFILIATES | -$216 | — | -$216 | — |
| OAKBRIDGE INSURANCE AGENCY LLC3 Filed as: OAKBRIDGE INSURANCE AGENCY, LLC | 200 BROADSTREET LAGRANGE, GA 30240 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AFFILIATES | -$3K | $0 | -$3K | — |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 233 S WACKER DR CHICAGO, IL 60606 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AFFILIATES | -$5K | $0 | -$5K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS LLC EIN 36-3086057 CLAIMS ADMINISTRATOR | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Other services; Contract Administrator; Direct payment from the plan Service code 12 | — | $79K |
| OAKBRIDGE INSURANCE AGENCY BROKER | Other commissions Service code 55 | 200 BROAD STREET LAGRANGE, GA 30240 | $56K |
| AETNA EIN 06-6033492 VENDOR SERVICES | Direct payment from the plan; Other services Service code 49 | — | $27K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATOR | Non-monetary compensation; Float revenue; Participant communication; Direct payment from the plan; Named fiduciary; Claims processing; Contract Administrator; Other services Service code 12 | — | $8K |
| CIGNA HEALTH AND LIDE INSURANCE CO | Named fiduciary; Direct payment from the plan; Contract Administrator; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | — | $0 |
| CIGNA LIFE AND HEALTH INSURANCE CO | Other services; Float revenue; Direct payment from the plan; Contract Administrator; Participant communication; Named fiduciary; Claims processing; Non-monetary compensation Service code 12 | — | $0 |
| WILLIS INSURANCE SERVICES BROKER | Other commissions Service code 55 | 5 CONCOURSE PKWY ATLANTA, GA 30328 | $0 |
| WILLIS TOWERS WATSON SOUTHEAST INC BROKER | Other commissions Service code 55 | 233 WACKER DR CHICAGO, IL 60606 | $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 | 174 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY | 176 | $546K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 176 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.