| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $22K | — | $22K | 3.84% |
| JOHN L BENN3 | 993 LISMORE DRIVE COLUMBUS, GA 31904 | AFLAC | $3K | — | $3K | 6.60% |
| JOHN E CARTER III3 | 1050 MOUNTAIN VIEW WAY PINE MOUNTAIN, GA 31822 | AFLAC | $1K | — | $1K | 2.59% |
| STEPHEN BRADLEY CANNON3 | 6524 GREGG DRIVE COLUMBUS, GA 31909 | AFLAC | $610 | — | $610 | 1.56% |
| TY EARL FAIR3 | 9569 ENGLISH IVY COURT FORTSON, GA 31808 | AFLAC | $584 | — | $584 | 1.49% |
| WHEELER INSURANCE SVCS LLC3 Filed as: WHEELER INSURANCE SERVICES LLC | P O BOX 1416 COLUMBUS, GA 31902 | AFLAC | $415 | — | $415 | 1.06% |
| MCGRIFF INSURANCE SERVICES INC3 | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | AFLAC | $362 | — | $362 | 0.93% |
| J STAN ALLEN INC3 | 1800 BUENA VISTA RD COLUMBUS, GA 31906 | AFLAC | $82 | — | $82 | 0.21% |
| CALVIN LEVI RENTZ3 | 1628 LEE ROAD 250 SALEM, AL 36874 | AFLAC | $76 | — | $76 | 0.19% |
| WILLIAM L AMOS & CO INC3 Filed as: WILLIAM L AMOS AND CO INC | 7100 STILLWATER DRIVE COLUMBUS, GA 31904 | AFLAC | $65 | — | $65 | 0.17% |
| J BECK INC3 | P O BOX 5386 COLUMBUS, GA 31906 | AFLAC | $33 | — | $33 | 0.08% |
| USI INSURANCE SERVICES LLC3 | 1001 LAKESIDE AVE E SUITE 1200 CLEVELAND, OH 44114 | AFLAC | $20 | — | $20 | 0.05% |
| JERALD DEE LEWARK3 | 6796 SCOTER DRIVE MIDLAND, GA 31820 | AFLAC | $19 | — | $19 | 0.05% |
| BRADLEY BOLICK3 Filed as: BRADLEY S BOLICK | 6433 FALL BRANCH DRIVE COLUMBUS, GA 31904 | AFLAC | $17 | — | $17 | 0.04% |
| TERESA LUMMUS3 Filed as: TERESA A LUMMUS | 145 OCONEE WOODS TRAIL SHARPSBURG, GA 30277 | AFLAC | $10 | — | $10 | 0.03% |
| WILLIAM L AMOS III3 | 7100 STILLWATER DRIVE COLUMBUS, GA 31904 | AFLAC | $9 | — | $9 | 0.02% |
| RPM LTD3 | P O BOX 1016 YULEE, FL 32041 | AFLAC | $8 | — | $8 | 0.02% |
| FRANK R GRIFFIN JR3 Filed as: FRANK R GRIVVIN JR | 8601 GARRETT ROAD P O BOX 233 MIDLAND, GA 31820 | AFLAC | $4 | — | $4 | 0.01% |
| GRACE C JACKSON3 | 5744 HIRAM ROAD POWDER SPRINGS, GA 30127 | AFLAC | $3 | — | $3 | 0.01% |
| JENNIFER SMITH3 Filed as: JENNIFER L SMITH | 4640 S STEWART AVE SPRINGFIELD, MO 65804 | AFLAC | $1 | — | $1 | 0.00% |
| SUE C TUCKER3 | 9856 US HIGHWAY 29 N CUSSETA, AL 36852 | AFLAC | $1 | — | $1 | 0.00% |
| C R RAMSEY POTTS3 | P O BOX 1016 YULEE, FL 32041 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL E MITMAN3 | 908 N WAYNE ST SUITE B ANGOLA, IN 46703 | AFLAC | $936 | — | $936 | 2.48% |
| JOHN L BENN3 | 993 LISMORE DR COLUMBUS, GA 31904 | AFLAC | $634 | — | $634 | 1.68% |
| JUSTIN D HARPER3 | 421 E COOK ROAD SUITE 400 FORT WAYNE, IN 46825 | AFLAC | $573 | — | $573 | 1.52% |
| TY EARL FAIR3 | 9568 ENGLISH IVY CT FORTSON, GA 31808 | AFLAC | $498 | — | $498 | 1.32% |
| CALVIN LEVI RENTZ3 | 1628 LEE ROAD 250 SALEM, AL 36874 | AFLAC | $439 | — | $439 | 1.16% |
| JOHN E CARTER III3 Filed as: JOHN E CARTER II | 1050 MOUNTAIN VIEW WAY PINE MOUNTAIN, GA 31822 | AFLAC | $339 | — | $339 | 0.90% |
| USI INSURANCE SERVICES LLC3 | 1001 LAKESIDE AVE E SUITE 1200 CLEVELAND, OH 44114 | AFLAC | $320 | — | $320 | 0.85% |
| JONATHAN DAVID BESWARICK3 | 250 ESTATES DR GIBSONIA, PA 15044 | AFLAC | $263 | — | $263 | 0.70% |
| MCGRIFF INSURANCE SERVICES INC3 | 3400 OVERTON PARK DR SUITE 300 ATLANTA, GA 30339 | AFLAC | $130 | — | $130 | 0.34% |
| KRISTINA A. ESSENBERG3 Filed as: KRISTINA A ESSENBERG | 1200 N 290 W ANGOLA, IN 46703 | AFLAC | $122 | — | $122 | 0.32% |
| LORI MINYARD3 Filed as: LORI E MINYARD | 14420 ALLISON DRIVE CARMEL, IN 46033 | AFLAC | $121 | — | $121 | 0.32% |
| WILLIAM L AMOS III3 | 7100 STILLWATER DRIVE COLUMBUS, GA 31904 | AFLAC | $84 | — | $84 | 0.22% |
| USI INSURANCE SERVICES LLC3 | 9910 DUPONT CIRCLE DR E SUITE 120 FORT WAYNE, IN 46825 | AFLAC | $66 | — | $66 | 0.17% |
| DAVID R KREMER3 | 20330 CHATHAM HILLS BLVD WESTFIELD, IN 46074 | AFLAC | $60 | — | $60 | 0.16% |
| STEPHEN BRADLEY CANNON3 | 6524 GREGG DRIVE COLUMBUS, GA 31909 | AFLAC | $43 | — | $43 | 0.11% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS INC | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | EYEMED VISION CARE | $5K | — | $5K | 15.70% |
| CALVIN LEVI RENTZ3 | 1628 LEE ROAD 250 SALEM, AL 36874 | AFLAC | $800 | — | $800 | 2.59% |
| JOHN L BENN3 | 993 LISMORE DRIVE COLUMBUS, GA 31904 | AFLAC | $750 | — | $750 | 2.43% |
| USI INSURANCE SERVICES LLC3 | 1001 LAKESIDE AVE E SUITE 1200 CLEVELAND, OH 44114 | AFLAC | $455 | — | $455 | 1.47% |
| JOHN E CARTER III3 | 1050 MOUNTAIN VIEW WAY PINE MOUNTAIN, GA 31822 | AFLAC | $400 | — | $400 | 1.30% |
| TY EARL FAIR3 | 9569 ENGLISH IVY CT FORTSON, GA 31808 | AFLAC | $332 | — | $332 | 1.08% |
| MICHAEL E MITMAN3 | 908 N WAYNE STREET SUITE B ANGOLA, IN 46703 | AFLAC | $192 | — | $192 | 0.62% |
| AJ BENEFITS INC3 | 7866 SLEEPY HOLLOW DR NORTHVILLE, MI 48168 | AFLAC | $174 | — | $174 | 0.56% |
| JUSTIN D HARPER3 | 421 E COOK ROAD SUITE 400 FORT WAYNE, IN 46825 | AFLAC | $160 | — | $160 | 0.52% |
| WILLIAM L AMOS & CO INC3 Filed as: WILLIAM L AMOS II | 7100 STILLWATER DRIVE COLUMBUS, GA 31904 | AFLAC | $121 | — | $121 | 0.39% |
| MICHAEL E MITMAN3 | 908 N WAYNE STREET SUITE B ANGOLA, IN 46703 | AFLAC | $95 | — | $95 | 0.31% |
| CHARLES V GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $86 | — | $86 | 0.28% |
| JONATHAN DAVID BESWARICK3 | 250 ESTATES DRIVE BIGSONIA, PA 15044 | AFLAC | $72 | — | $72 | 0.23% |
| HEIDI E GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $44 | — | $44 | 0.14% |
| BRADLEY BOLICK3 Filed as: BRADLEY S BOLICK | 6433 FALL BRANCH DRIVE COLUMBUS, GA 31904 | AFLAC | $38 | — | $38 | 0.12% |
| JESSICA R MAJOR3 | 1352 N DEERFIELD DRIVE CENTERVILLE, UT 84014 | AFLAC | $36 | — | $36 | 0.12% |
| DERRICK T JACKSON3 | P O BOX 10114 FORT WAYNE, IN 46850 | AFLAC | $23 | — | $23 | 0.07% |
| KEN MAJOR3 Filed as: KEN L MAJOR | 2211 MICHELSON DRIVE SUITE 1150 IRVINE, CA 92612 | AFLAC | $18 | — | $18 | 0.06% |
| C R RAMSEY POTTS3 | P O BOX 1016 YULEE, FL 32041 | AFLAC | $12 | — | $12 | 0.04% |
| FREDDIE LEE PRIME3 | 3701 MIRACLES BLVD APT 1301 DETROIT, MI 48201 | AFLAC | $7 | — | $7 | 0.02% |
| MCGRIFF INSURANCE SERVICES INC3 | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | EYEMED VISION CARE | $6 | — | $6 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMIN | Plan Administrator; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $266K |
| MCGRIFF SEIBELS AND WILLIAMS BROKER | Insurance agents and brokers; Insurance services Service code 22 | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | $41K |
| CIGNA | Participant communication; Contract Administrator; Float revenue; Other services; Claims processing; Direct payment from the plan; Named fiduciary; Non-monetary compensation Service code 12 | — | $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 | 243 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $567K |
| Vision(2 contracts) | EYEMED VISION CARE | 375 | $31K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 243 | $49K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $567K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $567K |
| Other(4 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 430 | $675K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.