| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | $807 | $16K | 10.43% |
| ACRISURE LLC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $268 | $5K | 10.38% |
| ACRISURE LLC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | CIGNA SUPPLEMENTAL HEALTH SOLUTIONS | $3K | — | $3K | 15.00% |
| ACRISURE LLC3 | DBA PEACHTREE BENEFIT GROUP 3580 PIERCE DRIVE, SUITE 100 CHAMBLEE, GA 30341 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $507 | $43 | $550 | 6.61% |
| ACRISURE LLC3 | DBA PEACHTREE BENEFIT GROUP 3850 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | — | $16 | $16 | 1.17% |
| ACRISURE LLC3 | 3580 PIERCE DRIVE SUITE 100 CHAMBLEE, GA 30341 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $8 | $8 | 0.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMIN | Non-monetary compensation; Claims processing; Other services; Float revenue; Named fiduciary; Participant communication; Contract Administrator; Direct payment from the plan Service code 12 | — | $240K |
| ACRISURE LLC BROKER | Insurance services; Insurance agents and brokers Service code 22 | 3580 PIERCE DRIE SUITE 100 CHAMBLEE, GA 30341 | $66K |
| CIGNA | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Claims processing; Non-monetary compensation; Named fiduciary; Float revenue Service code 12 | — | $0 |
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 | 169 | 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) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 169 | $149K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 169 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 169 | $52K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 375 | $687K |
| Other(5 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 169 | $181K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 375 | — |
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.