| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MULTIPLE BENEFITS CORPORATION3 | P.O. BOX 1205 LAWRENCEVILLE, GA 30046 | UNUM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 2.28% |
| BENEFITS ADVISORY GROUP3 | 3715 NORTHSIDE PKWY BLDG 200 SUITE 400 ATLANTA, GA 30327 | UNUM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 2.28% |
| MULTIPLE BENEFITS CORPORATION3 | P.O. BOX 1205 LAWRENCEVILLE, GA 30046 | BLUE CROSS BLUE SHIELD OF GEORGIA, INC | $6K | $0 | $6K | 4.28% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | 2300 RENAISSANCE BOULEVARD KING OF PRUSSIA, PA 19406 | BLUE CROSS BLUE SHIELD OF GEORGIA, INC | $4K | $0 | $4K | 3.08% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN | 300 WEST 10TH STREET WEST POINT, GA 31833 | BLUE CROSS BLUE SHIELD OF GEORGIA, INC | $2K | $0 | $2K | 1.21% |
| MULTIPLE BENEFITS CORPORATION3 | P.O. BOX 1205 LAWRENCEVILLE, GA 30046 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 2.49% |
| BENEFITS ADVISORY GROUP3 | 3715 NORTHSIDE PKWY BLDG 200 SUITE 400 ATLANTA, GA 30327 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 2.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BERKLEY LIFE & HEALTH INSURANCE CO EIN 91-6034263 STOP LOSS CARRIER | Claims processing Service code 12 | P.O. BOX 535298 ATLANTA, GA 30353 | $486K |
| BLUE CROSS BLUE SHIELD OF GA EIN 58-0469845 HEALTH CARRIER | Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $163K |
| MARSH & MCLELLAN EIN 26-3237576 AGENT | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | 5555 GLENRIDGE CONNECTOR SUITE 600 ATLANTA, GA 30342 | $100K |
| MULTIPLE BENEFITS CORP EIN 58-1297300 RX CONSULTANT | Insurance agents and brokers Service code 22 | P.O BOX 1205 LAWRENCEVILLE, GA 30046 | $88K |
| PARAGON BENEFITS EIN 58-1741732 CLAIMS PROCESSOR | Claims processing Service code 12 | 6065 BUSINESS PARK DRIVE COLUMBUS, GA 31909 | $67K |
| CAPTIVE SOLUTIONS & OPTIONS CAPTIVE FEE | Claims processing Service code 12 | 2870 PEACHTREE ROAD NW #304 ATLANTA, GA 30305 | $39K |
| UNUM LIFE INSURANCE COMPANY EIN 01-0278678 ADMIN FOR STD | Claims processing Service code 12 | — | $11K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 PRE-CERTIFICATION FEE | Claims processing Service code 12 | 7400 WEST CAMPUS ROAD F 510 NEW ALBANY, OH 43054 | $10K |
| BLUE CROSS BLUE SHIELD HEALTHCARE EIN 58-1638390 DENTAL VISION CLAIMS | Float revenue; Other services; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $5K |
| PARAGON BENEFITS, INC. EIN 58-1731742 FSA ADMIN | Contract Administrator; Claims processing Service code 12 | — | $3K |
| EXPRESS SCRIPTS INC EIN 16-1279199 RX | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator 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 | 420 | 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) | 420 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF GEORGIA, INC | 259 | $132K |
| Vision | BLUE CROSS BLUE SHIELD OF GEORGIA, INC | 259 | $132K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY | 420 | $291K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 420 | $233K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY | 420 | $291K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 420 | — |
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.