| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF, SEIBELS & WILLIAMS | 1 PREMIER PLAZA, 5605 GLENRIDGE DR ATLANTA, GA 30342 | PRUDENTIAL FINANCIAL | $2K | — | $2K | 0.29% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVE. CHICAGO, IL 60603 | PRUDENTIAL FINANCIAL | — | $375 | $375 | 0.05% |
| HARVARD PRINTING GROUP5 | PO BOX 380 WEST HEMPSTEAD, NY 11552 | PRUDENTIAL FINANCIAL | — | $95 | $95 | 0.01% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER & CO | PO BOX 70 WEST POINT, GA 31833 | HM LIFE INSURANCE COMPANY | $20K | — | $20K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF AL. EIN 63-0103830 | Claims processing Service code 12 | 450 RIVERCHASE PARKWAY EAST BIRMINGHAM, AL 35298 | $462K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 | Claims processing Service code 12 | TWO PERIMETER PARK SOUTH, STE 440 W BIRMINGHAM, AL 35243 | $29K |
| AMERITAS LIFE INSURANCE CORP. EIN 47-0098400 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | 611 POINTE NORTH BLVD ALBANY, GA 31721 | $15K |
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 | 1,030 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,030 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRUDENTIAL FINANCIAL | 1,030 | $789K |
| Short-term disability | PRUDENTIAL FINANCIAL | 1,030 | $789K |
| Long-term disability | PRUDENTIAL FINANCIAL | 1,030 | $789K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 716 | $396K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,030 | — |
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.