| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $0 | $421 | $421 | 0.08% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY STE 1950 ATLANTA, GA 30339 | FIRST UNUM LIFE INSURANCE COMPANY | $10K | $8K | $17K | 9.03% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY STE 1950 ATLANTA, GA 30339 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | $1K | $2K | 8.99% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY STE 1950 ATLANTA, GA 30339 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | $937 | $2K | 9.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue Service code 12 | — | $232K |
| DIGITAL INSURANCE LLC NONE | Insurance agents and brokers; Non-monetary compensation; Other commissions; Insurance brokerage commissions and fees Service code 22 | 400 GALLERIA PKWY #300 ATLANTA, GA 30339 | $32K |
| DELTA DENTAL OF NEW YORK EIN 11-1980218 NONE | Contract Administrator; Claims processing Service code 12 | — | $23K |
| WEX NONE | Claims processing; Contract Administrator Service code 12 | 4321 20TH AVE S FARGO, ND 58103 | $19K |
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 | 459 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 31 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 496 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 488 | $551K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 488 | $551K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 459 | $218K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 459 | $191K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 43 | $23K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 488 | $551K |
| Other(3 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 459 | $240K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 488 | — |
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."
No prospect flags tripped on this filing.