| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS & WILLIAMS OF GA | DRAWER 456 P O BOX 11407 BIRMINGHAM, AL 35246 | UNITED HEALTHCARE INSURANCE COMPANY | $23K | — | $23K | 10.04% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS OF GA | 5605 GLENRIDGE DRIVE SUITE 300 ATLANTA, GA 30342 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 7.50% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS OF TX | 818 TOWN AND COUNTRY BLVD SUITE 500 HOUSTON, TX 770244549 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $202 | — | $202 | 0.23% |
| AXA ASSISTANCE, USA3 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $129 | $129 | 0.15% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC GA | 5605 GLENRIDGE DRIVE SUITE 500 ATLANTA, GA 30342 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $176K |
| MCGRIFF SEIBELS AND WILLIAMS OF GA EIN 58-1834091 BROKER | Other commissions Service code 55 | — | $32K |
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 | 252 | 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) | 252 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 252 | $229K |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 252 | $229K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 252 | $229K |
| Life insurance(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 375 | $317K |
| Short-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 252 | $229K |
| Long-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 252 | $229K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 252 | $229K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 252 | $229K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 375 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 375 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.