| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | 5555 GLENRIDGE CONNECTOR SUITE 600 ATLANTA, GA 30115 | HARTFORD LIFE AND ACCIDENT | $70K | — | $70K | 7.35% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | 100 FRONT STREET SUITE 800 WORCESTER, MA 01608 | HARTFORD LIFE AND ACCIDENT | — | $33K | $33K | 3.45% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY LLC | 3625 N ELM STREET STE 200 GREENSBORO, NC 27455 | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | $51K | $23K | $74K | 13.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COVENANT ADMINISTRATORS CLAIMS ADMIN | Claims processing; Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | 2810 PREMIERE PARKWAY SUITE 400 DULUTH, GA 30097 | $710K |
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 | 500 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 500 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BERKLEY LIFE AND HEALTH INSURANCE CO | 551 | $761K |
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | 991 | $551K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | 991 | $551K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 749 | $948K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 749 | $948K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 749 | $948K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE AND HEALTH INSURANCE CO | 551 | $761K |
| Other | HARTFORD LIFE AND ACCIDENT | 749 | $948K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 991 | — |
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.