| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAVEN BENEFITS3 | 1000 PEACHTREE INDUSTRIAL BLVD 6437 SUWANEE, GA 30024 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | $233K | — | $233K | 5.14% |
| HAVEN BENEFITS3 Filed as: HAVEN BENEFITS, INC | 1000 PEACHTREE INDUSTRIAL BLVD STE 6437 SUWANEE, GA 30024 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $35K | $4K | $39K | 16.78% |
| HAVEN BENEFITS3 Filed as: HAVEN BENEFITS, INC | 1000 PEACHTREE INDUSTRIAL BLVD STE 6437 SUWANEE, GA 30024 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $19K | $2K | $21K | 16.81% |
| HAVEN BENEFITS3 Filed as: HAVEN BENEFITS, INC | 1000 PEACHTREE INDUSTRIAL BLVD STE 6437 SUWANEE, GA 30024 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | $2K | $19K | 16.88% |
| HAVEN BENEFITS3 Filed as: HAVEN BENEFITS, INC. | 1000 PEACHTREE INDUSTRIAL BLVE 6437 SUWANEE, GA 30024 | EYEMED VISION CARE | $3K | — | $3K | 10.03% |
| HAVEN BENEFITS3 Filed as: HAVEN BENEFITS, INC. | 1000 PEACHTREE INDUSTRIAL BLVD 6437 SUWANEE, GA 30024 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $345 | $3K | 16.89% |
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 | 330 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 340 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD OF GEORGIA, INC. | 899 | $343K |
| Vision | EYEMED VISION CARE | 900 | $33K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 798 | $234K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 386 | $127K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 386 | $112K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 386 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 900 | — |
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.