| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP INC | 3060 PEACHTREE ROAD NW STE 1650 ATLANTA, GA 30305 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | $52K | $95 | $52K | 3.28% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP, INC | 3060 PEACHTREE RD NW SUITE 1650 ATLANTA, GA 30305 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $26K | — | $26K | 15.00% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP INC | 3060 PEACHTREE ST NW STE 1650 ATLANTA, GA 30305 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | $6K | — | $6K | 5.24% |
| SAMANTHA LYNN WINNINGHAM3 | 3134 HUNT ROAD ACWORTH, GA 30102 | AFLAC | $3K | $188 | $3K | 9.05% |
| JEFFREY WINNINGHAM3 | 3134 HUNT RD ACWORTH, GA 30102 | AFLAC | $2K | — | $2K | 4.36% |
| CHRISTOPHER JAMES CORROW3 | 2796 ASHLEIGH LANE ALPHARETTA, GA 30004 | AFLAC | $662 | $37 | $699 | 1.98% |
| MICHAEL D AISSEN3 | 920 HOLCOMB BRIDGE RD STE 200 ROSWELL, GA 30076 | AFLAC | $434 | $38 | $472 | 1.34% |
| JESSE ROSS MORRIS3 | 1008 W SHADY GROVE RD IRMO, SC 29063 | AFLAC | $322 | — | $322 | 0.91% |
| DAVID C BERRY3 Filed as: DAVID BERRY | 2545 HEATHWAY DR FLORENCE, SC 29501 | AFLAC | $260 | — | $260 | 0.74% |
| DAVID G COMBS3 | 1041 WINDERMERE XING CUMMING, GA 30041 | AFLAC | $244 | — | $244 | 0.69% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JERRY WILLIS | 2870 PEACHTREE RD NW ATLANTA, GA 30305 | AFLAC | $181 | — | $181 | 0.51% |
| BRIDGETT DAIL3 | 5217 STONE STATION DRIVE RALEIGH, NC 27616 | AFLAC | $171 | — | $171 | 0.48% |
| RICHARD SMITHSON3 | 449 TIMBER PL MILTON, GA 30004 | AFLAC | $142 | — | $142 | 0.40% |
| SCOTT A SMITH3 Filed as: SCOTT SMITH | 5300 OAKBROOK PKWY BLDG 300 STE 350 NORCROSS, GA 30093 | AFLAC | $85 | $38 | $123 | 0.35% |
| ROBERT SPENCE YARBROUGH3 | 1820 THE EXCHANGE SE STE 750 ATLANTA, GA 30339 | AFLAC | $89 | — | $89 | 0.25% |
| ALEXANDER B WARD3 | 5194 FOREST VIEW CT SE MABLETON, GA 30126 | AFLAC | $89 | — | $89 | 0.25% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE LUCZAJ | 1201 MAIN ST STE 2300 COLUMBIA, SC 29201 | AFLAC | $81 | — | $81 | 0.23% |
| JACQUELINE NEAL3 | 3405 N OAK ST APT E MYRTLE BEACH, SC 29577 | AFLAC | $79 | — | $79 | 0.22% |
| THOMAS ROBERT GIDDENS3 | P O BOX 2517 KENNESAW, GA 30156 | AFLAC | $75 | — | $75 | 0.21% |
| REGGIE C BROCK3 Filed as: REGGIE BROCK | 188 WESTBROOK DR ACWORTH, GA 30101 | AFLAC | $63 | — | $63 | 0.18% |
| J KENNETH SKINNER3 | P O BOX 41 NASHVILLE, GA 31639 | AFLAC | $59 | — | $59 | 0.17% |
| TEATOR'S INS PROTECTION SERVICES3 | 524 TROUTWOOD PL FUQUAY VARINA, NC 27526 | AFLAC | $43 | — | $43 | 0.12% |
| PARTNERS BENEFIT GROUP LLC3 | 104 E 10TH ST TIFTON, GA 31794 | AFLAC | $38 | — | $38 | 0.11% |
| WILLIAM L BAKER IV3 Filed as: WILLIAM BAKER IV | 2310 S MIAMI BLVD STE 239 DURHAM, NC 27703 | AFLAC | $27 | — | $27 | 0.08% |
| DEREK B DAVIS3 Filed as: DEREK DAVIS | 1039 44TH AVE N STE 101 MYRTLE BEACH, SC 29577 | AFLAC | $25 | — | $25 | 0.07% |
| DAVID C CLOUD JR3 | 1301 SHILOH RD NW STE 1020 KENNESAW, GA 30144 | AFLAC | $25 | — | $25 | 0.07% |
| JUANITA A MOLTIMORE3 Filed as: JUANITA MOLTIMORE | 437 AUTUMN DRIVE RIVERDALE, GA 30274 | AFLAC | $24 | — | $24 | 0.07% |
| MRS JACKSON BOYUM3 | 2040 SKYLAR LEIGH DR BUFORD, GA 30518 | AFLAC | $21 | — | $21 | 0.06% |
| KELLY LEBSACK3 | 829 NORTH ELM ST GREENSBORO, NC 27410 | AFLAC | $16 | — | $16 | 0.05% |
| JUSTIN M GUIDI3 Filed as: JUSTIN GUIDI | 555 N PLEASANTBURG DR STE 200 GREENVILLE, SC 29607 | AFLAC | $16 | — | $16 | 0.05% |
| PAUL SHELBY AMOS II3 | 1932 WYNNTON RD 14TH FLOOR COLUMBUS, GA 31999 | AFLAC | $14 | — | $14 | 0.04% |
| RODNEY A MCCLURE3 Filed as: RODNEY MCCLURE | 606 REDBUD TERRACE CANTON, GA 30115 | AFLAC | $13 | — | $13 | 0.04% |
| LINDA W RABB3 Filed as: LINDA RABB | 58 FALLOW LANE ACWORTH, GA 30101 | AFLAC | $12 | — | $12 | 0.03% |
| SHARON D ROBERTS3 Filed as: SHARON ROBERTS | PO BOX 1129 YOUNG HARRIS, GA 30582 | AFLAC | $11 | — | $11 | 0.03% |
| SHERRI GOSS3 | 2517 MOODY RD STE 100 WARNER ROBINS, GA 31088 | AFLAC | $11 | — | $11 | 0.03% |
| BRIAN D ELY3 Filed as: BRIAN ELY | 1820 THE EXCHANGE SE STE 750 ATLANTA, GA 30339 | AFLAC | $10 | — | $10 | 0.03% |
| PODNAS INC / BECK & ASSOC3 Filed as: PODNAS INC/BECK & ASSOC | 6900 HILLTOP COURT COLUMBUS, GA 31904 | AFLAC | $7 | — | $7 | 0.02% |
| JONATHAN W MCCUTCHEON3 Filed as: JONATHAN MCCUTCHEON | 1150 MALLARD LAKE DR BOGART, GA 30622 | AFLAC | $7 | — | $7 | 0.02% |
| JOHN D TYLER3 | 130 DUCK HAWK WAY MARIETTA, SC 29661 | AFLAC | $6 | — | $6 | 0.02% |
| D REGAN BRANDON3 | 214 N NEWSOM ST MINEOLA, TX 75773 | AFLAC | $5 | — | $5 | 0.01% |
| LARRY W FLOWERS3 Filed as: LARRY FLOWERS | 2318 PROVINCIAL POINT DR GAINESVILLE, GA 30501 | AFLAC | $4 | — | $4 | 0.01% |
| RHONDA MICHELLE FREEMAN3 | 11853 COUNTY ROAD 167 TYLER, TX 75703 | AFLAC | $4 | — | $4 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 2502 N ROCKY POINT DR STE 400 TAMPA, FL 33607 | AFLAC | $3 | — | $3 | 0.01% |
| WILLIAM WARDLAW JR3 | 5300 OAKBROOK PKWY BLDG 300 STE 350 NORCROSS, GA 30093 | AFLAC | $1 | — | $1 | 0.00% |
No Schedule C service providers reported on this filing.
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 | 215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 219 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 175 | $1.6M |
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 342 | $118K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC | 342 | $118K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $211K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $175K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $175K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 215 | $217K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.