| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INSURANCE CTR | 125 MISSION STREET 26TH FLOOR SAN FRANCISCO, CA 94105 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | $1K | — | $1K | 1.62% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INSURANCE CENTER1 | 2405 SATELLITE BOULEVARD SUITE 200 DULUTH, GA 30096 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 13.89% |
| KLD INSURANCE BENEFITS INC3 | 8045 ROYAL SAINT GEORGES LANE DULUTH, GA 30097 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $749 | $699 | $1K | 10.98% |
| NORMAC SOLUTIONS INC3 | 3730 EVEREST DRIVE MONTGOMERY, AL 36106 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $479 | $263 | $742 | 5.63% |
| MITCHELL HECTOR MORALES3 | P O BOX 2532 NORCROSS, GA 30091 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $240 | $64 | $304 | 2.31% |
| B V STONE INC3 | 1800 SUNSET HARBOUR POINTE LAWRENCEVILLE, GA 30043 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $186 | $63 | $249 | 1.89% |
| CAROLE H WARREN3 | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $190 | $52 | $242 | 1.84% |
| CAROL PURDY FIELDS3 | 204 POTOMAC COURT WOODSTOCK, GA 30188 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $123 | $26 | $149 | 1.13% |
| MAGDALENA RUIZ DE GOMEZ3 | 163 STILLWOOD DRIVE NEWNAN, GA 30265 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $86 | $22 | $108 | 0.82% |
| TULLY AND COMPANY INC3 Filed as: TULLY AND COMPANY | 1926 STONE BRIDGE LANE MARIETTA, GA 30064 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $56 | $8 | $64 | 0.49% |
| JENNIFER ROSE SMITH3 | 4920 W SAN RAFAEL STREET TAMPA, FL 33629 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $28 | $10 | $38 | 0.29% |
| KATHERINE C ROBERTS3 | 8846 PICADILLY TRAIL OOLTEWAH, TN 37363 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $1 | $6 | 0.05% |
| DANA MARIE MOWATT3 | 23701 S WESTERN AVENUE #112 TORRANCE, CA 90501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.03% |
| NORTH FLORIDA BROKER SOLUTIONS LLC3 | 1550 HARRINGTON PARK DRIVE JACKSONVILLE, FL 32225 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $2 | $4 | 0.03% |
| CRAIG ALEXANDER MILLER3 | 2037 POWERS FERRY ROAD SE MARIETTA, GA 30067 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $2 | $4 | 0.03% |
| CLAUDIA BROOKE BODREY3 | 226 CANNON BRANCH ROAD CORDELE, GA 31015 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| MAX MARTIN LINDSAY3 | 2911 STAGE RUN DRIVE HIXSON, TN 37343 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.02% |
| ANNALIESE CLARK3 | 1336 HIDEWAWAY DRIVE S SAINT JOHNS, FL 32259 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTH PL GA EIN 58-1638390 BROKER | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Float revenue; Contract Administrator Service code 12 | — | $336K |
| EDGEWOOD PARTNERS INSURANCE CTR | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $13K |
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 | 249 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 314 | $84K |
| Dental | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 314 | $84K |
| Vision | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 314 | $84K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA | 314 | $84K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 249 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 314 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.