| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVID O WOODRUFF3 Filed as: DAVID O. WOODRUFF | P.O. BOX 80568 ATHENS, GA 30608 | CIGNA HEALTH AND LIFE INSURANCE | $38K | — | $38K | 12.45% |
| THE A.I. GROUP INC3 Filed as: THE A.I. GROUP | P.O. BOX 80568 ATHENS, GA 30608 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 7.50% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $39 | $39 | 0.04% |
| THE A.I. GROUP INC3 Filed as: THE A.I. GROUP, INC. | P.O. BOX 80568 ATHENS, GA 30608 | UNION SECURITY INSURANCE COMPANY | $6K | — | $6K | 9.21% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE INC. | 600 POPLAR AVE. MEMPHIS, TN 38119 | UNION SECURITY INSURANCE COMPANY | $554 | $3K | $4K | 5.07% |
| AI GROUP3 | 12725 MORRIS RD., B-100 STE. 200 ALPHARETTA, GA 30004 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | $1K | — | $1K | 9.27% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE INC. | P.O. BOX 80568 ATHENS, GA 30608 | AMERICAN HERITAGE LIFE | $3K | — | $3K | 23.31% |
| DANIEL H. PATTERSON3 Filed as: DANIEL HAMMOND PATTERSON | 2703 EAST LAKE ROAD MCDONOUGH, GA 30252 | AMERICAN HERITAGE LIFE | $173 | — | $173 | 1.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 INSURANCE CARRIER | Contract Administrator; Non-monetary compensation; Claims processing; Named fiduciary; Participant communication; Other services; Direct payment from the plan; Float revenue Service code 12 | — | $17K |
| CIGNA HEALTH & LIFE INSURANCE CO. | Claims processing; Float revenue; Non-monetary compensation; Contract Administrator; Participant communication; Named fiduciary; Other services; Direct payment from the plan 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 | 217 | 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) | 217 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE | 158 | $314K |
| Dental | UNION SECURITY INSURANCE COMPANY | 217 | $70K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 180 | $13K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 192 | $94K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 192 | $94K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 192 | $94K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 192 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 217 | — |
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.