| 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% |
| RJK & ASSOCIATES INC | 1800 PEACHTREE STREET NW ATLANTA, GA 30309 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $4K | $6K | 4.01% |
| INSURANCE OFFICE OF AMERICA | 1855 W STATE RD 434 LONGWOOD, FL 32750 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $233 | $4K | 3.11% |
| ROBERT E FENN Filed as: ROBERT FENN | 179 LAKE LURE DR ALMA, GA 31510 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $93 | $4K | 2.73% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES NATIONAL INC | 3475 PIEDMONT ROAD STE 800 ATLANTA, GA 30305 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 2.09% |
| PLM SOLUTIONS INC | 557 GRAVESROAD WEDOWEE, AL 36278 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $311 | $2K | 1.37% |
| BENEFIT COMMUNICATION SPECIALISTS | 37 W FAIRMONT AVE SAVANNAH, GA 31406 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $535 | $449 | $984 | 0.71% |
| ADVANCED BENEFIT SYSTEM INC | 145 RIVER LANDING DRIVE DANIEL ISLAND, SC 29492 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $200 | $204 | $404 | 0.29% |
| KLD INSURANCE BENEFITS INC | 9085 BETHEL RD GAINESVILLE, GA 30506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $388 | — | $388 | 0.28% |
| CHARLES D. BLOCK Filed as: CHARLES T FERGUSON | 859 SOUTHBRIDGE BLVD SAVANNAH, GA 31405 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $387 | — | $387 | 0.28% |
| CAROLE H WARREN | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $305 | — | $305 | 0.22% |
| B V STONE INC | 1800 SUNSET HARBOUR POINTE LAWRENCEVILLE, GA 30043 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $247 | — | $247 | 0.18% |
| CAROL PURDY FIELDS Filed as: CAROL FIELDS | 204 POTOMAC CT WOODSTOCK, GA 30188 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $183 | — | $183 | 0.13% |
| BURTON M HERRING JR Filed as: BURTON HERRING JR | 1135 ARLINGTON DR BIRMINGHAM, AL 35224 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | — | $137 | 0.10% |
| 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 | $63 | — | $63 | 0.05% |
| BSK BENEFITS PLUS LLC | 205 PINECREST DR COVINGTON, LA 70433 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| ELIZABETH SCHENK3 | 4725 SAND LAKE ROAD STE 300 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% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 203491 DALLAS, TX 75320 | ALLSTATE | $1K | — | $1K | 2.71% |
| BRUCE PHILLIPS3 | 4124 DANIEL GREEN TRAIL SMYRNA, GA 30080 | ALLSTATE | $1K | — | $1K | 2.60% |
| INSURANCE OFFICE OF AMERICA3 | PO BOX 162207 ALTAMONTE SPRINGS, FL 32716 | ALLSTATE | $788 | — | $788 | 1.74% |
| ROBERT E FENN3 Filed as: ROBERT FENN | 179 LAKE LURE DR ALMA, GA 31510 | ALLSTATE | $264 | — | $264 | 0.58% |
| MICHAEL PATE3 | 802 BOMBAY LN ROSWELL, GA 30076 | ALLSTATE | $181 | — | $181 | 0.40% |
| BRET STONE3 | 1800 SUNSET HARBOUR POINTE LAWRENCEVILLE, GA 30043 | ALLSTATE | $37 | — | $37 | 0.08% |
| CAROLE H WARREN3 Filed as: CAROLE WARREN | 1300 27TH PLACE SOUTH UNIT 46 BIRMINGHAM, AL 35205 | ALLSTATE | $34 | — | $34 | 0.07% |
| GEORGE WARREN3 | 1300 27TH PLACE SOUTH UNIT 46 BIRMINGHAM, AL 35205 | ALLSTATE | $33 | — | $33 | 0.07% |
| BURTON M HERRING JR3 Filed as: BURTON HERRING JR | 1135 ARLINGTON DR BIRMINGHAM, AL 35224 | ALLSTATE | $30 | — | $30 | 0.07% |
| TOMMY FIELDS3 | 204 POTOMAC CT WOODSTOCK, GA 30188 | ALLSTATE | $29 | — | $29 | 0.06% |
| CAROL PURDY FIELDS3 Filed as: CAROL FIELDS | 204 POTOMAC CT WOODSTOCK, GA 30188 | ALLSTATE | $24 | — | $24 | 0.05% |
| WAYNE MONROE DRYE3 | 6 CONCOURSE PKWY SUITE 3100 ATLANTA, GA 30328 | ALLSTATE | $8 | — | $8 | 0.02% |
| WAYNE MONROE DRYE3 | 2 RAVINIA DRIVE STE 1500 ATLANTA, GA 30346 | ALLSTATE | $2 | — | $2 | 0.00% |
| INSURANCE OFFICE OF AMERICA3 | 100 GALLERIA PKWY SE, STE 600 ATLANTA, GA 30339 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | — | $6K | 15.00% |
| ELIZABETH SCHENK3 | 4725 SAND LAKE ROAD STE 300 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 | 4725 SAND LAKE ROAD STE 300 ORLANDO, FL 32819 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $95 | — | $95 | 3.98% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 3475 PIEDMONT ROAD STE 800 ATLANTA, GA 30305 | THE PAUL REVERE LIFE INSURANCE COMPANY | $47 | — | $47 | 4.77% |
| CAROLE H WARREN3 | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | THE PAUL REVERE LIFE INSURANCE COMPANY | $22 | — | $22 | 2.23% |
| PLM SOLUTIONS INC3 | 557 GRAVESROAD WEDOWEE, AL 36278 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12 | — | $12 | 1.22% |
| KLD INSURANCE BENEFITS INC3 | 9085 BETHEL RD GAINESVILLE, GA 30506 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | — | $5 | 0.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTHCARE EIN 58-1638390 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing; Other services Service code 12 | — | $194K |
| CORESOURCE, INC. EIN 35-1846036 | Other services; Claims processing; Plan Administrator Service code 12 | — | $113K |
| INSURANCE OFFICE OF AMERICA EIN 59-2472656 | Insurance agents and brokers; Consulting (general) Service code 16 | — | $52K |
| BLUE CROSS AND BLUE SHIELD OF GEORG EIN 58-0469845 | Other services; Claims processing Service code 12 | — | $27K |
| ANTHEM EIN 95-4331852 | Claims processing; Other services Service code 12 | — | $23K |
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 | 347 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 347 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ALLSTATE | 6 | $45K |
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 275 | $168K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 462 | $40K |
| Life insurance(4 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 482 | $229K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 175 | $139K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 106 | $31K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 345 | $287K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 482 | $52K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 482 | — |
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.