| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | P.O. BOX 28852 NEW YORK, NY 10087 | METROPOLITAN LIFE INSURANCE COMPANY | $94K | — | $94K | 3.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | P.O. BOX 28852 NEW YORK, NY 10087 | HM LIFE INSURANCE COMPANY | $56K | — | $56K | 3.50% |
| PARTNERS BENEFIT GROUP LLC3 Filed as: PARTNERS BENEFIT GROUP, LLC | P.O. BOX 7770 TIFTON, GA 31793 | UNITED HEALTHCARE INSURANCE COMPANY - CA | $26K | — | $26K | 2.00% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELAWARE INC | PO BOX 741909 LOCK BOX #741909 ATLANTA, GA 30374 | UNITED HEALTHCARE INSURANCE COMPANY | $46K | — | $46K | 9.91% |
| PARTNERS BENEFIT GROUP LLC3 Filed as: PARTNERS BENEFIT GROUP, LLC | P.O. BOX 7770 TIFTON, GA 31793 | UNITED HEALTHCARE INSURANCE COMPANY | -$4K | — | -$4K | -0.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GEORGIA EIN 58-0469845 NONE | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $5.1M |
| ENVISIONRX EIN 90-1011712 NONE | Other services; Claims processing Service code 12 | 2181 E AURORA RD SUITE 201 TWINSBURG, OH 44087 | $4.6M |
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 | 4,173 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 72 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY - CA | 287 | $1.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 11,864 | $2.9M |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 2,956 | $469K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 1,029 | $385K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 4,846 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,864 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.