| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS. SCVS., INC. | PO BOX 632886 CINCINNATI, OH 45263 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | $3K | $0 | $3K | 5.00% |
| FREDERICK R SCHREMP3 | 3625 CUMBERLAND BLVD. SE, SUITE 800 ATLANTA, GA 30339 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 12.59% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS. SRVC., INC. | 700 W. 47TH ST. SUITE 1100 KANAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $855 | $855 | 2.19% |
| FREDERICK R SCHREMP3 | 3625 CUMBERLAND BLVD. SE, SUITE 800 ATLANTA, GA 30339 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS. SRVC., INC. | 700 W. 47TH ST. SUITE 1100 KANAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $176 | $176 | 2.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS. SVCS., INC. | PO BOX 632886 CINCINNATI, OH 452632886 | ADVANTICA REINSURANCE COMPANY | $382 | $0 | $382 | 7.00% |
| MARK RAYMOND3 | 8037 RIDGE VALLEY WOODSTOCK, GA 30189 | ADVANTICA REINSURANCE COMPANY | $164 | $0 | $164 | 3.01% |
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 | 103 | 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) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 139 | $54K |
| Vision | ADVANTICA REINSURANCE COMPANY | 71 | $5K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 98 | $39K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 98 | $39K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 121 | $226K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 98 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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.