| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 JOHNS CREEK, GA 30022 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 0.38% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY ALPHARETTA, GA 30022 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | $9K | — | $9K | 8.81% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY ALPHARETTA, GA 30022 | GREATER GEORGIA LIFE INSURANCE COMPANY | $8K | — | $8K | 9.30% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 JOHNS CREEK, GA 30022 | EYEMED VISION CARE | $1K | — | $1K | 9.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| RELATION INSURANCE INC BROKER | Insurance services; Insurance agents and brokers Service code 22 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 JOHNS CREEK, GA 30022 | $72K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMIN | Claims processing; Plan Administrator; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $26K |
| CIGNA | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication; Float revenue; Other services; Non-monetary compensation; Named fiduciary 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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 217 | $413K |
| Dental | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 302 | $98K |
| Vision | EYEMED VISION CARE | 251 | $14K |
| Life insurance | GREATER GEORGIA LIFE INSURANCE COMPANY | 175 | $86K |
| Short-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 175 | $86K |
| Long-term disability | GREATER GEORGIA LIFE INSURANCE COMPANY | 175 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 302 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.