| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE LLC/PEACHTREE BENEFIT GRP | 3580 PIERCE DRIVE SUITE 100 ATLANTA, GA 30341 | DELTA DENTAL INSURANCE COMPANY | $12K | — | $12K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF GA EIN 58-1638390 PLAN ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Other services; Claims processing Service code 12 | — | $377K |
| ACRISURE LLC | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $152K |
| BLUE CROSS BLUE SHIELD HEALTH PL GA | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $121K |
| ANTHEM INSURANCE COMPANIES EIN 35-0781558 PLAN ADMIN | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services Service code 12 | — | $46K |
| INGENIOXRX EIN 82-3062245 PHARM ADMIN | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | -$56K |
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 | 290 | 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) | 290 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL INSURANCE COMPANY | 501 | $120K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 518 | $407K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 518 | — |
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.