| 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 | $61K | — | $61K | 10.05% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 1.13% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 18.29% |
| GREEN, HARRIS, SCOTT3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 18.39% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 19.53% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $521 | — | $521 | 2.79% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $322 | — | $322 | 1.72% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $322 | — | $322 | 1.72% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $158 | — | $158 | 0.84% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $141 | — | $141 | 1.08% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $141 | — | $141 | 1.08% |
| GREEN, HARRIS, SCOTT3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $67 | — | $67 | 0.51% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.28% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 21.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $428 | — | $428 | 20.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GA G0386 CLAIMS PROCESSING | Contract Administrator; Float revenue; Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3350 PEACHTREE ROAD, NE ATLANTA, GA 30326 | $768K |
| MCGRIFF INSURANCE SERVIVCES INC THIRD-PARTY | Insurance agents and brokers; Non-monetary compensation; Insurance brokerage commissions and fees; Other commissions Service code 22 | 5130 PARKWAY PLAZA BLVD CHARLOTTE, NC 28217 | $88K |
| MOT FINANCIAL SERVICES THIRD-PARTY | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 3333 PEACHTREE ROAD NE ATLANTA, GA 30326 | $81K |
| INGENIORX, INC. EIN 82-3062245 THIRD-PARTY | Claims processing; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $20K |
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 | 478 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 478 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 424 | $1.0M |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 478 | $742K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 478 | $617K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 478 | $604K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 424 | $1.0M |
| Other(9 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 478 | $825K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 478 | — |
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.