| 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) | $257K | $0 | $257K | 3.32% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0386) | $60K | $0 | $60K | 3.32% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0386) | $15K | $0 | $15K | 3.32% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $20K | $0 | $20K | 17.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $15K | $0 | $15K | 17.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 17.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0385) | $2K | $0 | $2K | 3.32% |
| HAVEN BENEFITS1 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 17.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH6 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS5 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 17.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH1 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 17.02% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $880 | $0 | $880 | 17.01% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS1 | 1000 PEACHTREE INDUSTRIAL BLVD SUIT SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $308 | $0 | $308 | 17.02% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH6 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $60 | $0 | $60 | 17.14% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD SUWANEE, GA 30024 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6 | $0 | $6 | 16.67% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 110 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
| COMPSYCH5 | 455 N. CITYFRONT PLAZA DRIVE CHICAGO, IL 606115322 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | — | $0 | 0.00% |
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 | 578 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 79 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 657 | 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) | 992 | $9.6M |
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0386) | 1,277 | $453K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. (G0385) | 1,247 | $58K |
| Life insurance(4 contracts) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 536 | $140K |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 535 | $78K |
| Long-term disability(2 contracts) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 536 | $159K |
| Other(4 contracts) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 644 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,277 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.