| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA3 | 2839 PACES FERRY RD, STE 1200 ATLANTA, GA 30339 | COMPANION LIFE INSURANCE COMPANY | $35K | — | $35K | 12.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | PO BOX 601478 CHARLOTTE, NC 282601478 | COMPANION LIFE INSURANCE COMPANY | $7K | — | $7K | 2.50% |
| INSURANCE OFFICE OF AMERICA3 | 2839 PACES FERRY RD, STE 1200 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $12K | — | $12K | 7.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | 25 BULL ST SAVANNAH, GA 31401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 2.43% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $270 | — | $270 | 0.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | PO BOX 203491 DALLAS, TX 75320 | ALLSTATE | $8K | — | $8K | 15.98% |
| BRUCE PHILLIPS3 | 4124 DANIEL GREEN TRAIL SMYRNA, GA 30080 | ALLSTATE | $5K | — | $5K | 10.18% |
| ROBERT E FENN3 Filed as: ROBERT FENN | 179 LAKE LURE DR ALMA, GA 31510 | ALLSTATE | $322 | — | $322 | 0.61% |
| MICHAEL PATE3 | 802 BOMBAY LN ROSWELL, GA 30076 | ALLSTATE | $309 | — | $309 | 0.59% |
| GEORGE WARREN3 | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | ALLSTATE | $73 | — | $73 | 0.14% |
| CARLE H WARREN3 Filed as: CARLE WARREN | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | ALLSTATE | $66 | — | $66 | 0.13% |
| BRET STONE3 | 1800 SUNSET HARBOUR POINTE LAWRENCEVILLE, GA 30043 | ALLSTATE | $66 | — | $66 | 0.13% |
| TOMMY FIELDS3 | 204 POTOMAC CT WOODSTOCK, GA 30188 | ALLSTATE | $51 | — | $51 | 0.10% |
| BURTON M HERRING JR3 Filed as: BURTON HERRING JR | 1135 ARLINGTON DR BIRMINGHAM, AL 35224 | ALLSTATE | $50 | — | $50 | 0.09% |
| CAROL PURDY FIELDS3 Filed as: CAROL FIELDS | 204 POTOMAC CT WOODSTOCK, GA 30188 | ALLSTATE | $49 | — | $49 | 0.09% |
| WAYNE MONROE DRYE3 | 6 CONCOURSE PKWY ATLANTA, GA 30328 | ALLSTATE | $16 | — | $16 | 0.03% |
| INSURANCE OFFICE OF AMERICA3 | 2839 PACES FERRY RD, STE 1200 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 11.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | 25 BULL ST SAVANNAH, GA 31401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 3.99% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $587 | — | $587 | 1.49% |
| INSURANCE OFFICE OF AMERICA3 | 100 GALLERIA PKWY SE, STE 600 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 11.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | 25 BULL ST SAVANNAH, GA 31401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 3.39% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $206 | — | $206 | 0.60% |
| INSURANCE OFFICE OF AMERICA3 | 1855 W STATE RD 434 LONGWOOD, FL 32750 | NATIONAL VISION ADMINISTRATORS, LLC | $1K | — | $1K | 4.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | 600 SOUTH 4TH ST, 11TH FL MINNEAPOLIS, MN 55415 | NATIONAL VISION ADMINISTRATORS, LLC | $228 | — | $228 | 0.79% |
| INSURANCE OFFICE OF AMERICA3 | 2839 PACES FERRY RD, STE 1200 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 10.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | 25 BULL ST SAVANNAH, GA 31401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 4.06% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $318 | — | $318 | 1.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | 25 BULL ST SAVANNAH, GA 31401 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $130 | — | $130 | 5.05% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $9 | — | $9 | 0.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | 3475 PIEDMONT ROAD STE 800 ATLANTA, GA 30305 | THE PAUL REVERE LIFE INSURANCE COMPANY | $95 | — | $95 | 6.71% |
| CAROLE H WARREN3 | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | THE PAUL REVERE LIFE INSURANCE COMPANY | $69 | $12 | $81 | 5.72% |
| PLM SOLUTIONS INC3 | 3244 WINTERBERRY CIRCLE MARIETTA, GA 30062 | THE PAUL REVERE LIFE INSURANCE COMPANY | $26 | $3 | $29 | 2.05% |
| KLD INSURANCE BENEFITS INC3 | 9085 BETHEL RD GAINESVILLE, GA 30506 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12 | $3 | $15 | 1.06% |
| KLINGBEIL AND ASSOCIATES INC3 | 6000 LAKE FORREST DRIVE ATLANTA, GA 30328 | THE PAUL REVERE LIFE INSURANCE COMPANY | $7 | — | $7 | 0.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INSURANCE OFFICE OF AMERICA | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $21K |
| WELLS FARGO INS SERVICES USA INC | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $8K |
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 | 396 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 396 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ALLSTATE | 164 | $53K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 267 | $155K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 446 | $29K |
| Life insurance(3 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 375 | $75K |
| Short-term disability | THE PAUL REVERE LIFE INSURANCE COMPANY | 174 | $1K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 122 | $28K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 331 | $281K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 375 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 446 | — |
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.