| 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 | $56K | — | $56K | 12.44% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 0.70% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 20.00% |
| GREEN, HARRIS, SCOTT | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 20.00% |
| MOT FINANCIAL SERVICES LLC3 | 4 CONCOURSE PKWY 3RD FLOOR STE 300 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $271 | — | $271 | 2.80% |
| GREEN, HARRIS, SCOTT3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $95 | — | $95 | 0.98% |
| GREEN, HARRIS, SCOTT3 | 4 CONCOURSE PKWY 3RD FLOOR STE 300 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GA G0386 CLAIMS PROCESSING | Other commissions; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Contract Administrator; Insurance agents and brokers; Claims processing; Insurance brokerage commissions and fees Service code 12 | 3350 PEACHTREE ROAD, NE ATLANTA, GA 30326 | $556K |
| BLUE CROSS BLUE SHIELD OF GA G0385 EIN 58-0469845 CLAIMS PROCESSING | Other services; Contract Administrator; Claims processing; Other fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3350 PEACHTREE ROAD, NE ATLANTA GA, GA 30326 | $97K |
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 | 455 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 455 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 414 | $277K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 397 | $789K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $524K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $456K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $447K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 397 | $789K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $546K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 455 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.