| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CMA AGENCY3 Filed as: CMA AGENCY, INC | 305 GREEN STREET NW GAINESVILLE, GA 30501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 9.25% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | 3438 PEACHTREE ROAD NE SUITE 1100 ATLANTA, GA 30326 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $184 | $0 | $184 | 0.75% |
| CMA AGENCY3 Filed as: CMA AGENCY INC | 305 GREEN STREET NW GAINESVILLE, GA 30501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 9.06% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | 3438 PEACHTREE RD NE SUITE 1100 ATLANTA, GA 30326 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $221 | $0 | $221 | 0.94% |
| CMA AGENCY3 Filed as: CMA AGENCY INC | 305 GREEN STREET GAINESVILLE, GA 30501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 9.04% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | 3438 PEACHTREE RD NE SUITE 1100 ATLANTA, GA 30326 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $169 | $0 | $169 | 0.96% |
| CMA AGENCY3 Filed as: CMA AGENCY, INC | 305 GREEN STREET NW GAINESVILLE, GA 30501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 9.06% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: NORTHWESTERN BENEFIT CORP OF GA | 3438 PEACHTREE RD NE SUITE 1100 ATLANTA, GA 30326 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $134 | $0 | $134 | 0.94% |
| CMA AGENCY3 Filed as: CMA AGENCY, INC | P.O. BOX 918 GAINESVILLE, GA 30503 | FIDELITY SECURITY LIFE INSURANCE COMPANY/ AVESIS | $1K | $0 | $1K | 9.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT SUPPORT INC EIN 58-1644374 TPA | Plan Administrator; Contract Administrator; Claims processing Service code 12 | P.O. BOX 2977 GAINESVILLE, GA 30503 | $64K |
| CMA AGENCY EIN 58-2094944 BROKER | Insurance agents and brokers Service code 22 | P.O. BOX 918 GAINESVILLE, GA 30503 | $42K |
| CHAR LEE CORP DBA MANAGED CARE CONC EIN 86-0799129 HOSPITAL PRE-CERITIFICAT | Other fees Service code 99 | P.O. BOX 4541 TOPEKA, KS 66604 | $10K |
| NORTH GEORGIA HEALTH PARTNERS EIN 58-2131807 TPA | Claims processing; Plan Administrator; Contract Administrator Service code 12 | 743 SPRING STREET GAINESVILLE, GA 30501 | $5K |
| FIRST HEALTH GROUP CORP EIN 20-1736437 TPA | Claims processing; Plan Administrator; Contract Administrator Service code 12 | 3200 HIGHLAND AVE DOWNERS GROVE, IL 60515 | $5K |
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 | 110 | 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) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY/ AVESIS | 200 | $14K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 188 | $42K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 187 | $14K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 188 | $24K |
| Stop-loss / reinsurancereinsurance | EASTERN INSURANCE GROUP, LLC | 0 | $356K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 188 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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.