| 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 | $43K | — | $43K | 15.00% |
| INSURANCE OFFICE OF AMERICA3 | 100 GALLERIA PKWY SE, STE 600 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $17K | — | $17K | 10.00% |
| ELIZABETH SCHENK3 | 4725 SAND LAKE ROAD STE 300 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 1.00% |
| INSURANCE OFFICE OF AMERICA | 1855 W STATE RD 434 LONGWOOD, FL 32750 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $816 | $4K | 3.18% |
| ROBERT E FENN Filed as: ROBERT FENN | 179 LAKE LURE DR ALMA, GA 31510 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $115 | $4K | 2.84% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INS SVCS USA, INC | 3475 PIEDMONT ROAD STE 800 ATLANTA, GA 30305 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 2.66% |
| RJK & ASSOCIATES INC | 777 DREWRY ST NE ATLANTA, GA 30306 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 2.03% |
| PLM SOLUTIONS INC | 3244 WINTERBERRY CIRCLE MARIETTA, GA 30062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $295 | $2K | 1.41% |
| BENEFIT COMMUNICATION SPECIALISTS | 37 W FAIRMONT AVE SAVANNAH, GA 31406 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $585 | $151 | $736 | 0.53% |
| KLD INSURANCE BENEFITS INC | 9085 BETHEL RD GAINESVILLE, GA 30506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $452 | $20 | $472 | 0.34% |
| CHARLES D. BLOCK Filed as: CHARLES T FERGUSON | 454 OLEANDER WAY HARDEEVILLE, SC 29927 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $457 | — | $457 | 0.33% |
| ADVANCED BENEFIT SYSTEM INC | 245 SEVEN FARMS DRIVE DANIEL ISLAND, SC 29492 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $220 | $189 | $409 | 0.30% |
| BRUCE PHILLIPS | 4124 DANIEL GREEN TRAIL SMYRNA, GA 30080 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $371 | — | $371 | 0.27% |
| CAROLE H WARREN | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $364 | — | $364 | 0.26% |
| B V STONE INC | 1800 SUNSET HARBOUR POINTE LAWRENCEVILLE, GA 30043 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $264 | — | $264 | 0.19% |
| CAROL PURDY FIELDS Filed as: CAROL FIELDS | 204 POTOMAC CT WOODSTOCK, GA 30188 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $198 | — | $198 | 0.14% |
| BURTON M HERRING JR Filed as: BURTON HERRING JR | 1135 ARLINGTON DR BIRMINGHAM, AL 35224 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $175 | — | $175 | 0.13% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS INSURANCE SERVICES OF GEORGI | 1 GLENLAKE PKWY FI 11 ATLANTA, GA 30328 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | — | $79 | 0.06% |
| HOWARD HOROWITZ | 2610 ALCOTT STREET CARMEL, IN 46032 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $8 | $42 | 0.03% |
| KLINGBEIL AND ASSOCIATES INC | 6000 LAKE FORREST DRIVE ATLANTA, GA 30328 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.02% |
| PARRISH J PEACHEE Filed as: PARRISH PEACHEE | 201 W 103RD ST INDIANAPOLIS, IN 46290 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| BSK BENEFITS PLUS LLC | 205 PINECREST DR COVINGTON, LA 70433 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| BRUCE PHILLIPS3 | 4124 DANIEL GREEN TRAIL SMYRNA, GA 30080 | ALLSTATE | $2K | — | $2K | 3.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA, INC | PO BOX 203491 DALLAS, TX 75320 | ALLSTATE | $2K | — | $2K | 3.59% |
| INSURANCE OFFICE OF AMERICA3 | PO BOX 162207 ALTAMONTE SPRINGS, FL 32716 | ALLSTATE | $2K | — | $2K | 3.52% |
| ROBERT E FENN3 Filed as: ROBERT FENN | 179 LAKE LURE DR ALMA, GA 31510 | ALLSTATE | $474 | — | $474 | 0.89% |
| MICHAEL PATE3 | 802 BOMBAY LN ROSWELL, GA 30076 | ALLSTATE | $283 | — | $283 | 0.53% |
| CAROLE H WARREN3 Filed as: CAROLE WARREN | 1300 27TH PLACE SOUTH UNIT 46 BIRMINGHAM, AL 35205 | ALLSTATE | $42 | — | $42 | 0.08% |
| BRET STONE3 | 1800 SUNSET HARBOUR POINTE LAWRENCEVILLE, GA 30043 | ALLSTATE | $42 | — | $42 | 0.08% |
| GEORGE WARREN3 | 1300 27TH PLACE SOUTH UNIT 46 BIRMINGHAM, AL 35205 | ALLSTATE | $36 | — | $36 | 0.07% |
| BURTON M HERRING JR3 Filed as: BURTON HERRING JR | 1135 ARLINGTON DR BIRMINGHAM, AL 35224 | ALLSTATE | $33 | — | $33 | 0.06% |
| TOMMY FIELDS3 | 204 POTOMAC CT WOODSTOCK, GA 30188 | ALLSTATE | $32 | — | $32 | 0.06% |
| CAROL PURDY FIELDS3 Filed as: CAROL FIELDS | 204 POTOMAC CT WOODSTOCK, GA 30188 | ALLSTATE | $26 | — | $26 | 0.05% |
| WAYNE MONROE DRYE3 | 6 CONCOURSE PKWY ATLANTA, GA 30328 | ALLSTATE | $11 | — | $11 | 0.02% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $8K | $8K | 16.00% |
| INSURANCE OFFICE OF AMERICA3 | 100 GALLERIA PKWY SE, STE 600 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 15.00% |
| INSURANCE OFFICE OF AMERICA3 | 100 GALLERIA PKWY SE, STE 600 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | — | $6K | 15.01% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 4.00% |
| INSURANCE OFFICE OF AMERICA3 | 1855 W STATE RD 434 LONGWOOD, FL 32750 | NATIONAL VISION ADMINISTRATORS, LLC | $2K | — | $2K | 5.00% |
| INSURANCE OFFICE OF AMERICA3 | 100 GALLERIA PKWY SE, STE 600 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| ELIZABETH SCHENK3 | 6900 TURKEY LANE RD, STE 200 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $317 | — | $317 | 1.05% |
| ELIZABETH SCHENK3 | 4725 SAND LAKE ROAD STE 300 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $98 | — | $98 | 4.02% |
| NORMAC SOLUTIONS INC3 | 3730 EVEREST DR. MONTGOMERY, AL 36106 | THE PAUL REVERE LIFE INSURANCE COMPANY | $48 | $3 | $51 | 5.41% |
| 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 | $47 | — | $47 | 4.98% |
| CAROLE H WARREN3 | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | THE PAUL REVERE LIFE INSURANCE COMPANY | $22 | — | $22 | 2.33% |
| PLM SOLUTIONS INC3 | 3244 WINTERBERRY CIRCLE MARIETTA, GA 30062 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12 | — | $12 | 1.27% |
| KLD INSURANCE BENEFITS INC3 | 9085 BETHEL RD GAINESVILLE, GA 30506 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | — | $5 | 0.53% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTHCARE EIN 58-1638390 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing; Float revenue Service code 12 | — | $200K |
| CORESOURCE, INC. EIN 35-1846036 | Other services; Plan Administrator; Claims processing Service code 12 | — | $94K |
| BLUE CROSS AND BLUE SHIELD OF GEORG EIN 58-0469845 | Claims processing; Other services Service code 12 | — | $56K |
| INSURANCE OFFICE OF AMERICA EIN 59-2472656 | Consulting (general); Insurance agents and brokers Service code 16 | — | $43K |
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 | 361 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 361 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ALLSTATE | 210 | $53K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 293 | $172K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 478 | $33K |
| Life insurance(4 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 398 | $228K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 177 | $139K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 117 | $30K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 364 | $287K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 398 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 478 | — |
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.