| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PEACHTREE BENEFIT GROUP INC3 Filed as: PEACHTREE BENEFIT GROUP | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 15.00% |
| PEACHTREE BENEFIT GROUP INC3 Filed as: PEACHTREE BENEFIT GROUP | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 15.00% |
| PEACHTREE BENEFIT GROUP INC3 Filed as: PEACHTREE BENEFIT GROUPQ | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $655 | — | $655 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 ADMIN SERVICES | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Claims processing; Contract Administrator Service code 12 | — | $118K |
| PEACHTREE BENEFIT GROUP INS BROKER | Insurance services; Insurance agents and brokers Service code 22 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 303412109 | $72K |
| CONNECTICUT GENERAL LIFE INS CO | Contract Administrator; Direct payment from the plan; Named fiduciary; Non-monetary compensation; Claims processing; Float revenue; Participant communication; Other services Service code 12 | — | $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 | 132 | 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) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 145 | $809K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 145 | $809K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 145 | $809K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 145 | $34K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 145 | $27K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 145 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 145 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.