| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS OF GA | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $166K | — | $166K | 2.01% |
| MCGRIFF INSURANCE SERVICES INC3 | 645 HAMILTON STREET SUITE 1002 ALLENTOWN, PA 18101 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $53K | — | $53K | 0.64% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS OF GA | P O BOX 896620 CHARLOTTE, NC 28289 | HARTFORD LIFE AND ACCIDENT | $87K | $14K | $101K | 11.61% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS OF GA | 3400 OVERTON PARK DR SUITE 300 ATLANTA, GA 30339 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $10K | $16K | 2.96% |
| ASHFORD ADVISORS INC3 Filed as: ASHFORD ADVISORS | ONE RAVINIA DRIVE SUITE 1750 ATLANTA, GA 30346 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $733 | — | $733 | 0.14% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | PAN-AMERICAN LIFE INSURANCE COMPANY | $24K | — | $24K | 10.17% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF SEIBELS AND WILLIAMS | P O BOX 896620 CHARLOTTE, NC 28289 | PAN-AMERICAN LIFE INSURANCE COMPANY | $7K | — | $7K | 3.08% |
| MCGRIFF INSURANCE SERVICES INC3 | P O BOX 896620 CHARLOTTE, NC 28289 | VISION SERVICE PLAN | $1K | — | $1K | 1.25% |
| THE BOON INSURANCE AGENCY3 | 6300 BRIDGEPOINT PARKWAY AUSTIN, TX 78730 | TRANSAMERICA LIFE INSURANCE COMPANY | $9K | — | $9K | 10.78% |
| MCGRIFF INSURANCE SERVICES INC3 | 3605 GLENWOOD AVENUE SUITE 201 RALEIGH, NC 27612 | TRANSAMERICA LIFE INSURANCE COMPANY | $5K | — | $5K | 5.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MCGRIFF SEIBELS AND WILLIAMS CONSULTING FEES | Insurance services; Insurance agents and brokers Service code 22 | 3400 OVERTON PARK DRIVE SUITE 300 ATLANTA, GA 30339 | $19K |
| BOON ADMINISTRATIVE SERVICES INC EIN 33-0044933 CLAIMS PROC | Contract Administrator; Claims processing; Other insurance fees and expenses Service code 12 | — | $15K |
| PAM-AMERICAN LIFE EIN 72-0281240 CLAIMS PROC | Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $13K |
| PAN AMERICAN BENEFIT SOLUTIONS NETWORK ACCESS FEES | Other insurance fees and expenses Service code 73 | 1778 NO PLANO ROAD SUITE 310 RICHARDSON, TX 75081 | $11K |
| MCGRIFF INSURANCE SERVICES CONSULTING FEES | Other services; Other fees Service code 49 | P O BOX 896620 CHARLOTTE, NC 28289 | $2K |
| RXEDO PHARM BENE MGR | Other fees Service code 99 | P O BOX 678586 DALLAS, TX 75267 | $303 |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | 1,359 | $8.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,204 | $536K |
| Vision | VISION SERVICE PLAN | 1,182 | $87K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 2,103 | $952K |
| Long-term disability(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 2,103 | $952K |
| Stop-loss / reinsurancereinsurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 171 | $239K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 2,103 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,103 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.