| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY SUITE 200 JOHNS CREEK, GA 30022 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GA | $64K | $22K | $86K | 11.87% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY JOHNS CREEK, GA 30022 | STANDARD INSURANCE COMPANY | $42K | — | $42K | 10.67% |
| LAZER SPOT INC3 | 6525 SHILOH ROAD SUITE 900 ALPHARETTA, GA 30005 | STANDARD INSURANCE COMPANY | — | $11K | $11K | 2.84% |
| KDM SIGNS INC3 | KDM POP SOLUTIONS GROUP P O BOX 639091 CINCINNATI, OH 45263 | STANDARD INSURANCE COMPANY | — | $900 | $900 | 0.23% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY JOHNS CREEK, GA 30022 | STANDARD INSURANCE COMPANY | $54K | — | $54K | 14.65% |
| LAZER SPOT INC3 | 6525 SHILOH ROAD SUITE 900 ALPHARETTA, GA 30005 | STANDARD INSURANCE COMPANY | — | $11K | $11K | 2.88% |
| KDM SIGNS INC3 | KDM POP SOLUTIONS GROUP P O BOX 639091 CINCINNATI, OH 45263 | STANDARD INSURANCE COMPANY | — | $850 | $850 | 0.23% |
| RELATION INSURANCE INC3 | 5825 MEDLOCK BRIDGE PARKWAY JOHNS CREEK, GA 30022 | STANDARD INSURANCE COMPANY | $32K | — | $32K | 10.13% |
| LAZER SPOT INC3 | 6525 SHILOH ROAD SUITE 900 ALPHARETTA, GA 30005 | STANDARD INSURANCE COMPANY | — | $9K | $9K | 2.90% |
| KDM SIGNS INC3 | KDM POP SOLUTIONS GROUP P O BOX 639091 CINCINNATI, OH 45263 | STANDARD INSURANCE COMPANY | — | $75 | $75 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF GA EIN 58-1638390 CLAIMS ADMIN | Other services; Float revenue; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $576K |
| BLUE CROSS BLUE SHIELD HEALTHCARE | Insurance agents and brokers; Non-monetary compensation; Other commissions Service code 22 | — | $5K |
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 | 1,464 | 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) | 1,464 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GA | 2,521 | $721K |
| Vision | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GA | 2,521 | $721K |
| Life insurance | STANDARD INSURANCE COMPANY | 2,614 | $366K |
| Short-term disability | STANDARD INSURANCE COMPANY | 988 | $321K |
| Long-term disability | STANDARD INSURANCE COMPANY | 795 | $393K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,614 | — |
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.