| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | $4K | — | $4K | 4.25% |
| PEACHTREE BENEFIT GROUP INC3 Filed as: PEACHTREE BENEFIT PARTNERS OF GA | 3580 PIERCE DRIVE SUITE 100 ATLANTA, GA 30341 | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | $3K | — | $3K | 2.97% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $245 | $5K | 14.52% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFITS CORP | 3438 PEACHTREE ROAD PHIPPS TOWER SUITE 1100 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $414 | $138 | $552 | 1.56% |
| PEACHTREE BENEFIT GROUP INC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $203 | $4K | 14.75% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFITS CORP | 3438 PEACHTREE ROAD PHIPPS TOWER SUITE 1100 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $451 | $150 | $601 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTHCARE EIN 58-1638390 CLAIMS ADMIN | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services Service code 12 | — | $265K |
| ACRISURE LLC | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $21K |
| PEACHTREE BENEFIT PARTNERS OF GA | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $17K |
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 | 163 | 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) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | 258 | $90K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA INC | 258 | $90K |
| Life insurance | GREATER GEORGIA LIFE INSURANCE COMPANY | 160 | $8K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 34 | $30K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 34 | $30K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 101 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 258 | — |
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.