| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GERALD L URSREY3 | 63 PLAYERS CLUB VILLAS RD PONTE VEDRA BEACH, FL 32082 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 5.88% |
| T J O BRIEN AND ASSOCIATES INC3 | STE 232 1899 POWERS FERRY RD SE ATLANTA, GA 30339 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 2.00% |
| PARTNERS BENEFIT GROUP LLC3 Filed as: PARTNERS BENEFIT GROUP, LLC | 1476 CARPENTER ROAD S TIFTON, GA 31793 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $785 | $3K | 7.08% |
| PARTNERS BENEFIT GROUP LLC3 Filed as: PARTNERS BENEFIT GROUP, LLC | 1476 CARPENTER ROAD TIFTON, GA 31793 | SUN LIFE INSURANCE COMPANY | $453 | — | $453 | 10.02% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EDISON HEALTH SOLUTIONS, LLC | 68 | $360K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 117 | $38K |
| Life insurance | SUN LIFE INSURANCE COMPANY | 65 | $5K |
| Short-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 175 | $58K |
| Other | EDISON HEALTH SOLUTIONS, LLC | 68 | $360K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.