| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $25K | — | $25K | 11.55% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 5.07% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | KAISER FOUNDATION HEALTH PLAN INC | $6K | — | $6K | 3.36% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE SUITE 300 ATLANTA, GA 30342 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $16K | — | $16K | 14.86% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 10.01% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 7.40% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 5605 GLENRIDGE DRIVE NE SUITE 300 ATLANTA, GA 30342 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $316 | — | $316 | 14.98% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH STREET HAMMONTON, NJ 08037 | FIRST UNUM LIFE INSURANCE COMPANY | $13 | $3 | $16 | 5.69% |
| MICHAEL H GODWIN3 Filed as: MICHAEL A VILLA | DOMINIUM BENEFITS 5 CONCOURSE PARKWAY SUITE 2325 ATLANTA, GA 30328 | FIRST UNUM LIFE INSURANCE COMPANY | $1 | — | $1 | 0.36% |
No Schedule C service providers reported on this filing.
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 | 2,626 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 2,626 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,626 | $2.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,626 | $1.8M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,626 | $1.8M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 808 | $204K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 826 | $106K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 808 | $219K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,626 | $1.8M |
| Other(6 contracts, 4 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,626 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,626 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.