| 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 | $65K | — | $65K | 10.86% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 1.33% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $25K | — | $25K | 20.00% |
| GREEN, HARRIS, SCOTT3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 20.00% |
| M O T FINANCIAL SERVICES LLC3 | STE 150 3720 DAVINCI CT PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 17.42% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $389 | $4K | 13.82% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $162 | $4K | 13.07% |
| SMITH, THOMAS, CHRISTOPHER3 | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $208 | — | $208 | 0.69% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $278 | $4K | 18.91% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $117 | $4K | 18.11% |
| MOT FINANCIAL SERVICES LLC3 | 4 CONCOURSE PKWY 3RD FLOOR STE 300 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $609 | — | $609 | 3.01% |
| GREEN, HARRIS, SCOTT3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $83 | — | $83 | 0.41% |
| GREEN, HARRIS, SCOTT3 | 4 CONCOURSE PKWY 3RD FLOOR STE 300 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GA G0386 CLAIMS PROCESSING | Other commissions; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Float revenue; Other fees; Claims processing; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 12 | 3350 PEACHTREE ROAD, NE ATLANTA, GA 30326 | $925K |
| INGENIORX, INC. THIRD-PARTY | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $9K |
| BLUE CROSS BLUE SHIELD OF GA G0385 | Other fees; Other services Service code 49 | — | $227 |
| MCGRIFF INSURANCE SERVIVCES INC THIRD-PARTY | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 223 W NASH ST WILSON, NC 27893 | $0 |
| MOT FINANCIAL SERVICES THIRD-PARTY | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | 3333 PEACHTREE ROAD NE ATLANTA, GA 30326 | $0 |
| REGIONS INSURANCE INC THIRD-PARTY | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | PO BOX 2121, DEPT 1336 MEMPHIS, TN 38159 | $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 | 453 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 453 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 410 | $902K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 453 | $741K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 453 | $619K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 453 | $598K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 410 | $902K |
| Other(6 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 453 | $809K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 453 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.