| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. (G0386) | $181K | $0 | $181K | 4.80% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0385) | $58K | $0 | $58K | 4.80% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | $12K | $0 | $12K | 5.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 17.05% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $822 | $822 | 1.50% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $38 | $38 | 0.07% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 17.05% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $747 | $747 | 1.50% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $34 | $34 | 0.07% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0385) | $2K | $0 | $2K | 4.80% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 17.05% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $588 | $588 | 1.50% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $27 | $27 | 0.07% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 17.05% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $378 | $378 | 1.50% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $17 | $17 | 0.07% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 17.05% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $154 | $154 | 1.50% |
| AXA ASSISTANCE, USA3 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $7 | $7 | 0.07% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $787 | $0 | $787 | 17.04% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $69 | $69 | 1.49% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $3 | $3 | 0.06% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $574 | $0 | $574 | 17.05% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $50 | $50 | 1.49% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $2 | $2 | 0.06% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $215 | $0 | $215 | 17.08% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $19 | $19 | 1.51% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $1 | $1 | 0.08% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12 | $0 | $12 | 16.67% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $1 | $1 | 1.39% |
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 | 392 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 28 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 420 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. (G0386) | 726 | $5.0M |
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 387 | $240K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0385) | 916 | $46K |
| Life insurance(4 contracts) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 389 | $87K |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 389 | $39K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 389 | $55K |
| Other(3 contracts) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 498 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 916 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.