| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | PO BOX 71429 NEWNAN, GA 30271 | AMERITAS LIFE INSURANCE CORP | $8K | $0 | $8K | 8.19% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | 11330 LAKEFIELD DRIVE SUITE 100 BLDG 1 DULUTH, GA 30097 | AMERITAS LIFE INSURANCE CORP | $0 | $2K | $2K | 2.07% |
| BIA BENEFITS CONSULTING LLC3 Filed as: BIA BENEFITS CONSULTING, LLC | 823 CHICKAMAUGA AVE ROSSVILLE, GA 30741 | AMERITAS LIFE INSURANCE CORP | $2K | $0 | $2K | 1.81% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | PARK 80 W PLAZA TWO 250 PEHILE AVE SUITE 400 SADDLE BROOK, NJ 07663 | AMERITAS LIFE INSURANCE CORP | $0 | $217 | $217 | 0.21% |
| FREDERICK VAN PATTEN3 | 4350 SAINT ANDREWS CREST CUMMING, GA 30040 | MONY LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 5.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CYPRESS BENEFIT ADMINISTRATORS LLC EIN 39-1997579 CONTRACT ADMIN | Claims processing Service code 12 | 5560 W GRANDE MARKET DRIVE APPLETON, WI 54913 | $51K |
| BIA BENEFITS CONSULTING LLC EIN 20-8266101 AGENT | Custodial (securities) Service code 19 | 823 CHICKAMAUGA AVENUE ROSSVILLE, GA 30741 | $44K |
| CONNECTICUT GENERAL EIN 06-0303370 OTHER | Other fees Service code 99 | PO BOX 645014 CINCINNATI, OH 45264 | $23K |
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 | 131 | 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) | 131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC BENEFIT CORP | 131 | $486K |
| Dental | AMERITAS LIFE INSURANCE CORP | 129 | $102K |
| Vision | AMERITAS LIFE INSURANCE CORP | 129 | $102K |
| Life insurance | MONY LIFE INSURANCE COMPANY OF AMERICA | 142 | $100K |
| Short-term disability | MONY LIFE INSURANCE COMPANY OF AMERICA | 142 | $100K |
| Long-term disability | MONY LIFE INSURANCE COMPANY OF AMERICA | 142 | $100K |
| Other | MONY LIFE INSURANCE COMPANY OF AMERICA | 142 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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.