| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $44K | $0 | $44K | 14.15% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE, INC. | 6000 POPLAR STE 300 MEMPHIS, TN 38119 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | $2K | $0 | $2K | 8.15% |
| MOT FINANCIAL SERVICES LLC3 Filed as: MOT FINANCIAL SERVICES | 4 CONCOURSE PKWY, 3RD FLR, STE 300 ATLANTA, GA 30328 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | $1K | $0 | $1K | 4.86% |
| THE A.I. GROUP INC3 Filed as: THE A.I. GROUP INC. | 12725 MORRIS RD, BLDG 100, STE 200 ALPHARETTA, GA 30004 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | -$464 | $0 | -$464 | -2.21% |
| MOT FINANCIAL SERVICES LLC3 Filed as: MOT FINANCIAL SERVICES | 4 CONCOURSE PKWY, 3RD FLOOR STE 300 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $394 | $0 | $394 | 5.14% |
| THOMAS C SMITH3 Filed as: THOMAS C. SMITH | PO BOX 6650 METAIRIE, TN 70009 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $212 | $0 | $212 | 2.76% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $177 | $0 | $177 | 2.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GEORGIA EIN 58-0469845 CLAIMS PROCESSING | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other fees; Claims processing; Other services Service code 12 | 3350 PEACHTREE ROAD, NE ATLANTA, GA 30326 | $493K |
| BLUE CROSS BLUE SHIELD HCP EIN 58-1638390 CLAIMS PROCESSING | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 3350 PEACHTREE ROAD, NE ATLANTA, GA 30326 | $100K |
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 | 177 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 142 | $113K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 135 | $21K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 177 | $322K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 26 | $8K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 177 | $314K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 177 | $322K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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.