| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 | P.O. BOX 896620 CHARLOTTE, NC 28289 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $56K | — | $56K | 6.00% |
| MOT FINANCIAL SERVICES LLC3 | 37 DAVINCI COURT, STE 150 PEACHTREE CORNERS, GA 30092 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $37K | — | $37K | 4.00% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $60K | — | $60K | 10.94% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 1.24% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 19.98% |
| MOT FINANCIAL SERVICES LLC3 | 37 DAVINCI COURT, STE 150 PEACHTREE CORNERS, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 12.40% |
| MOT FINANCIAL SERVICES LLC3 | 3720 DAVINCI CT STE 150 ATLANTA, GA 30092 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 12.75% |
| GREEN, HARRIS, SCOTT3 Filed as: GREEN, HARRIS S | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $880 | — | $880 | 5.25% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $165 | — | $165 | 9.98% |
| HARRIS S GREEN3 | 3333 PEACHTREE RD NE STE 550 ATLANTA, GA 30326 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $241 | — | $241 | 14.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CLAIMS PROCESSING | Non-monetary compensation; Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Other services; Named fiduciary; Participant communication Service code 12 | 900 COTTAGE GROVE RD BLOOMFIELD, CT 06002 | $346K |
| 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 | $56K |
| MOT FINANCIAL SERVICES THIRD-PARTY | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 3333 PEACHTREE ROAD NE ATLANTA, GA 30326 | $35K |
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 | 356 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 356 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 785 | $932K |
| Life insurance(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 356 | $680K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 356 | $552K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 356 | $550K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 785 | $932K |
| Other(7 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 356 | $724K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 785 | — |
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.