| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | $15 | — | $15 | 0.00% |
| MCGRIFF INSURANCE SERVICES INC3 | P.O. BOX 896620 CHARLOTTE, NC 28289 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | $12 | — | $12 | 0.00% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $69K | — | $69K | 11.98% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 1.34% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $26K | — | $26K | 21.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 12.56% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 8.60% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $525 | — | $525 | 2.92% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $371 | — | $371 | 2.06% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $371 | — | $371 | 2.06% |
| SMITH, THOMAS, CHRISTOPHER3 | 798 BERRY RD NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $48 | — | $48 | 0.27% |
| VAN EPPS, JAMES, H3 | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $101 | — | $101 | 0.99% |
| BLOCK, CHARLES, D3 | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $101 | — | $101 | 0.99% |
| GREEN, HARRIS, SCOTT3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $66 | — | $66 | 0.65% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.27% |
| GREEN, HARRIS, SCOTT3 | 37 DAVINCI COURT, STE 150 ATLANTA, GA 30092 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.08% |
| ATLANTA OFFICE, DIRECT BUSINESS COR3 | 6 CONCOURSE PKWY NE STE 2700 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $783 | — | $783 | 32.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF GA G0386 EIN 58-1638390 CLAIMS PROCESSING | Claims processing; Float revenue; Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3350 PEACHTREE ROAD, NE ATLANTA, GA 30326 | $999K |
| 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 | $91K |
| MCGRIFF INSURANCE SERVIVCES INC THIRD-PARTY | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 223 W NASH ST WILSON, NC 27893 | $89K |
| INGENIO RX INC. EIN 82-3062245 THIRD-PARTY | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing Service code 12 | 450 HEADQUATERS PLAZA MORRISTOWN, NJ 07960 | $24K |
| BLUE CROSS BLUE SHIELD OF GA G0385 | Other fees; Other services Service code 49 | — | $27 |
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 | 457 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 457 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 409 | $1.0M |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 457 | $701K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 457 | $584K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 457 | $573K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 409 | $1.0M |
| Other(6 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 457 | $787K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 457 | — |
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.