| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 LOCK BOX #28852 NEW YORK, NY 100878852 | BLUE CROSS OF CALIFORNIA | $29K | $0 | $29K | 1.99% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 LOCK BOX 28852 NEW YORK, NY 100878852 | UNITED HEALTHCARE INSURANCE COMPANY | $71K | $0 | $71K | 9.60% |
| WILLIS TOWERS WATSON US LLC3 | — | DELTA DENTAL INSURANCE COMPANY | $107K | — | $107K | 30.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBS HEALTHCARE PLAN OF GEORGIA, IN EIN 58-1638390 SERVICE PROVIDER | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $6.8M |
| ELIXIR RX EIN 90-1011712 SERVICE PROVIDER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | — | $3.5M |
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 | 5,491 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 32 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 5,523 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 130 | $1.5M |
| Dental | DELTA DENTAL INSURANCE COMPANY | 13,722 | $348K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 12,521 | $735K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 130 | $1.5M |
| Stop-loss / reinsurancereinsurance | SWISS RE CORPORATE SOLUTIONS | 5,400 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 13,722 | — |
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."
No prospect flags tripped on this filing.