| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| XS INSURANCE, INC. | 2809 LASSITER ROAD BLDG C, STE 250 MARIETTA, GA 30062 | AMALGAMATED LIFE INSURANCE COMPANY | $9K | — | $9K | 3.68% |
| NELSON INSURANCE AGENCY3 Filed as: NELSON INSURANCE COMPANY | 1143 SHIPWATCH CIRCLE TAMPA, FL 33602 | 5STAR LIFE INSURANCE COMPANY | $13K | — | $13K | 10.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CLAIMS ADMINISTRATOR | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $719K |
| SOUTHERN BENEFIT ADMINISTRATORS INC EIN 62-1116095 | Contract Administrator; Consulting (general); Participant communication; Copying and duplicating; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing Service code 12 | — | $599K |
| MEDCO EIN 22-3461740 | Other services; Claims processing; Participant communication; Direct payment from the plan Service code 12 | — | $46K |
| J. ALLEN BELL, JR. CPA EIN 58-1499502 | Accounting (including auditing) Service code 10 | — | $35K |
| ATLANT CAPITAL MANAGEMENT EIN 58-2236910 | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $29K |
| PARKER, HUDSON, RAINER & DOBBS, LLC EIN 58-1423485 | Legal Service code 29 | — | $28K |
| SUNTRUST BANK EIN 58-0466330 | Account maintenance fees Service code 65 | — | $10K |
| UNITED MEMBERS INSURANCE COMPANY | Insurance services Service code 23 | — | $9K |
| UNITED ACTUARIAL SERVICES, INC. EIN 35-2156428 | Actuarial Service code 11 | — | $7K |
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 | 2,370 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,381 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | 5STAR LIFE INSURANCE COMPANY | 3,890 | $117K |
| Stop-loss / reinsurancereinsurance | AMALGAMATED LIFE INSURANCE COMPANY | 1,681 | $235K |
| Other | 5STAR LIFE INSURANCE COMPANY | 3,890 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,890 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.