| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 | EB COMMISSION P O BOX 896620 CHARLOTTE, NC 28289 | STARMOUNT LIFE INSURANCE COMPANY | $16K | $8K | $24K | 15.02% |
| JOHN L BENN3 | 993 LISMORE DRIVE COLUMBUS, GA 31904 | AFLAC | $6K | $89 | $6K | 11.53% |
| STEPHEN BRADLEY CANNON3 | 6524 GREGG DRIVE COLUMBUS, GA 31909 | AFLAC | $2K | $21 | $2K | 4.46% |
| MCGRIFF INSURANCE SERVICES INC3 | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | AFLAC | $2K | — | $2K | 4.14% |
| JOHN E CARTER III3 | 1050 MOUNTAIN VIEW WAY PINE MOUNTAIN, GA 31822 | AFLAC | $2K | $21 | $2K | 3.53% |
| TY EARL FAIR3 | 9569 ENGLISH IVY COURT FORTSON, GA 31808 | AFLAC | $493 | — | $493 | 0.99% |
| WHEELER INSURANCE SVCS LLC3 Filed as: WHEELER INSURANCE SERVICES LLC | P O BOX 1416 COLUMBUS, GA 31902 | AFLAC | $366 | — | $366 | 0.73% |
| CALVIN LEVI RENTZ3 | 1628 LEE ROAD 250 SALEM, AL 36874 | AFLAC | $74 | — | $74 | 0.15% |
| J STAN ALLEN INC3 | 1800 BUENA VISTA ROAD COLUMBUS, GA 31906 | AFLAC | $70 | — | $70 | 0.14% |
| WILLIAM L AMOS & CO INC3 | 7100 STILLWATER DRIVE COLUMBUS, GA 31906 | AFLAC | $60 | — | $60 | 0.12% |
| J BECK INC3 | P O BOX 5386 COLUMBUS, GA 31906 | AFLAC | $29 | — | $29 | 0.06% |
| USI INSURANCE SERVICES LLC3 | 1001 LAKESIDE AVE E SUITE 1200 CLEVELAND, OH 44114 | AFLAC | $20 | — | $20 | 0.04% |
| JERALD DEE LEWARK3 | 6796 SCOTER DRIVE MIDLAND, GA 31820 | AFLAC | $19 | — | $19 | 0.04% |
| BRADLEY BOLICK3 Filed as: BRADLEY S BOLICK | 6433 FALL BRANCH DRIVE COLUMBUS, GA 31904 | AFLAC | $15 | — | $15 | 0.03% |
| TERESA LUMMUS3 Filed as: TERESA A LUMMUS | 145 OCONEE WOODS TRAIL SHARPSBURG, GA 30277 | AFLAC | $9 | — | $9 | 0.02% |
| WILLIAM L AMOS III3 | 7100 STILLWATER DRIVE COLUMBUS, GA 31904 | AFLAC | $8 | — | $8 | 0.02% |
| RPM LTD3 | P O BOX 1016 YULEE, FL 32041 | AFLAC | $7 | — | $7 | 0.01% |
| FRANK R GRIFFIN JR3 | P O BOX 233 8601 GARRETT ROAD 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 AVENUE 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 Filed as: MICHAEL MITMAN | 909 N WAYNE STREET SUITE B ANGOLA, IN 46703 | AFLAC | $2K | $26 | $2K | 4.46% |
| JOHN L BENN3 | 993 LISMORE DRIVE COLUMBUS, GA 31904 | AFLAC | $1K | $11 | $1K | 2.70% |
| MCGRIFF INSURANCE SERVICES INC3 | 3400 OVERTON PARK DRIVE SE SUITE 300 ATLANTA, GA 30339 | AFLAC | $1K | — | $1K | 2.57% |
| JUSTIN D HARPER3 | 10007 NORTHBROOK VALLEY DRIVE APT 10 FORT WAYNE, IN 46825 | AFLAC | $857 | $6 | $863 | 1.93% |
| TY EARL FAIR3 | 9569 ENGLISH IVY COURT FORTSON, GA 31808 | AFLAC | $496 | — | $496 | 1.11% |
| JOHN E CARTER III3 | 1050 MOUNTAIN VIEW WAY PINE MOUNTAIN, GA 31822 | AFLAC | $464 | $3 | $467 | 1.04% |
| CALVIN LEVI RENTZ3 | 1628 LEE ROAD 250 SALEM, AL 36874 | AFLAC | $446 | — | $446 | 1.00% |
| DERRICK T JACKSON3 | P O BOX 10114 FORT WAYNE, IN 46850 | AFLAC | $440 | — | $440 | 0.98% |
| USI INSURANCE SERVICES LLC3 | 1001 LAKESIDE AVENUE E SUITE 1200 CLEVELAND, OH 44114 | AFLAC | $324 | — | $324 | 0.72% |
| JONATHAN DAVID BESWARICK3 | 250 ESTATES DRIVE GIBSONIA, PA 15044 | AFLAC | $252 | — | $252 | 0.56% |
| STEPHEN BRADLEY CANNON3 | 6524 GREGG DRIVE COLUMBUS, GA 31909 | AFLAC | $229 | $3 | $232 | 0.52% |
| KRISTINA A. ESSENBERG3 Filed as: KRISTINA A ESSENBERG | 1200 N 290 W ANGOLA, IN 46703 | AFLAC | $116 | — | $116 | 0.26% |
| LORI MINYARD3 Filed as: LORI E MINYARD | 14420 ALLISON DRIVE CARMEL, IN 46033 | AFLAC | $115 | — | $115 | 0.26% |
| WILLIAM L AMOS III3 | 7100 STILLWATER DRIVE COLUMBUS, GA 31904 | AFLAC | $85 | — | $85 | 0.19% |
| USI INSURANCE SERVICES LLC3 | 9910 DUPONT CIRCLE DRIVE E SUITE 120 FORT WAYNE, IN 46825 | AFLAC | $63 | — | $63 | 0.14% |
| DAVID R KREMER3 | 20330 CHATHAM HILLS BLVD WESTFIELD, IN 46074 | AFLAC | $58 | — | $58 | 0.13% |
| CALVIN LEVI RENTZ3 | 1628 LEE ROAD 250 SALEM, AL 36874 | AFLAC | $586 | — | $586 | 2.52% |
| JOHN L BENN3 | 993 LISMORE DRIVE COLUMBUS, GA 31904 | AFLAC | $586 | — | $586 | 2.52% |
| USI INSURANCE SERVICES LLC3 | 1001 LAKESIDE AVE E SUITE 1200 CLEVELAND, OH 44114 | AFLAC | $337 | — | $337 | 1.45% |
| MICHAEL E MITMAN3 | 908 N WAYNE ST SUITE B ANGOLA, IN 46703 | AFLAC | $295 | $30 | $325 | 1.40% |
| JOHN E CARTER III3 | 1050 MOUNTAIN VIEW WAY PINE MOUNTAIN, GA 31822 | AFLAC | $299 | — | $299 | 1.28% |
| TY EARL FAIR3 | 9569 ENGLISH IVY COURT FORTSON, GA 31808 | AFLAC | $237 | — | $237 | 1.02% |
| MICHAEL E MITMAN3 | 908 N WAYNE ST SUITE B ANGOLA, IN 46703 | AFLAC | $229 | — | $229 | 0.98% |
| JUSTIN D HARPER3 | 10007 NORTHBROOK VALLEY DRIVE APT 10 FORT WAYNE, IN 46825 | AFLAC | $176 | $7 | $183 | 0.79% |
| DERRICK T JACKSON3 | P O BOX 10114 FORT WANE, IN 46850 | AFLAC | $112 | $7 | $119 | 0.51% |
| AJ BENEFITS INC3 | 7866 SLEEPY HOLLOW DR NORTHVILLE, MI 48168 | AFLAC | $114 | — | $114 | 0.49% |
| WILLIAM L AMOS III3 | 7100 STILLWATER DRIVE COLUMBUS, GA 31904 | AFLAC | $88 | — | $88 | 0.38% |
| CHARLES V GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $70 | — | $70 | 0.30% |
| JONATHAN DAVID BESWARICK3 | 250 ESTATES DRIVE GIBSONIA, PA 15044 | AFLAC | $51 | — | $51 | 0.22% |
| HEIDI E GLAUB3 | 4404 SAINT ANDREWS ST HOWELL, MI 48843 | AFLAC | $36 | — | $36 | 0.15% |
| BRADLEY BOLICK3 Filed as: BRADLEY S BOLICK | 5433 FALL BRANCH DRIVE COLUMBUS, GA 31904 | AFLAC | $28 | — | $28 | 0.12% |
| STEPHEN BRADLEY CANNON3 | 6524 GREGG DRIVE COLUMBUS, GA 31909 | AFLAC | $16 | — | $16 | 0.07% |
| C R RAMSEY POTTS3 Filed as: CR RAMSEY POTTS | P O BOX 1016 YULEE, FL 32041 | AFLAC | $8 | — | $8 | 0.03% |
| JESSICA R MAJOR3 | 1352 N DEERFIELD DRIVE CENTERVILLE, UT 84014 | AFLAC | $7 | — | $7 | 0.03% |
| FREDDIE LEE PRIME3 | 3701 MIRACLES BLVD APT 1301 DETROIT, MI 48201 | AFLAC | $6 | — | $6 | 0.03% |
| KEN MAJOR3 Filed as: KEN L MAJOR | 2211 MICHELSON DRIVE SUITE 1150 IRVINE, CA 92612 | AFLAC | $4 | — | $4 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTH PL GA EIN 58-1638390 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services; Contract Administrator Service code 12 | — | $155K |
| MCGRIFF INSURANCE SERVICES | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | — | $53K |
| STEALTH PARTNER GROUP LLC NONE | Other fees Service code 99 | 18700 N HAYDEN ROAD SUITE 405 SCOTTSDALE, AZ 85255 | $33K |
| INGENIORX EIN 82-3062245 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator; Float revenue 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 | 285 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 285 | $652K |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 316 | $159K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 316 | $159K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 285 | $90K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 285 | $12K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 285 | $32K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 285 | $652K |
| Other(5 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 285 | $214K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 316 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.