| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE, INC. | 1150 JULIAN DR STE 100 WATKINSVILLE, GA 30677 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $43K | — | $43K | 18.52% |
| THE A.I. GROUP INC3 Filed as: THE A I GROUP | 1150 JULIAN DRIVE WATKINSVILLE, GA 30677 | SUN LIFE ASSURANCE COMPANY OF CANADA | $21K | — | $21K | 12.56% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE | PO BOX 80568 ATHENS, GA 30608 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | — | $7K | 4.15% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS COALITION SERVICES, LLC | 7632 SW DURHAM RD SUITE 115 TIGARD, OR 97224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 2.72% |
| UMR, INC.3 | 115 W WAUSAU AVENUE WAUSAU, WI 54401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $950 | — | $950 | 0.58% |
| AI GROUP3 Filed as: THE AI GROUP INC. | PO BOX 80568 ATHENS, GA 30608 | UNION SECURITY INSURANCE COMPANY | $7K | — | $7K | 9.12% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE | 300 COLONIAL CENTER PKWY STE 200 ROSWELL, GA 30076 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 2.15% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE | 300 COLONIAL CENTER PKWY STE 200 ROSWELL, GA 30076 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 2.06% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE, INC. | 6000 POPLAR AVE MEMPHIS, TN 38119 | UNION SECURITY INSURANCE COMPANY | $693 | — | $693 | 0.89% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE | 300 COLONIAL CENTER PKWY STE 200 ROSWELL, GA 30076 | UNION SECURITY INSURANCE COMPANY | $373 | — | $373 | 0.48% |
| REGIONS INSURANCE INC3 Filed as: REGIONS INSURANCE, INC. | 1150 JULIAN DR STE 100 WATKINSVILLE, GA 30677 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 18.21% |
| AI GROUP3 Filed as: THE AI GROUP, INC. | 12725 MORRIS RD ALPHARETTA, GA 30004 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | $2K | — | $2K | 10.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MGMNT | Other fees; Float revenue; Direct payment from the plan; Claims processing Service code 12 | 2300 MAIN STREET IRVINE, CA 92614 | $143K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $128K |
| THE A I GROUP EIN 58-2510431 BROKER | Other commissions Service code 55 | — | $39K |
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | ONE FOUNTIAN SQUARE 3WEST CHATTANOOGA, TN 37402 | $6K |
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 | 269 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 272 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNION SECURITY INSURANCE COMPANY | 148 | $78K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 202 | $14K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 281 | $258K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 281 | $231K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 213 | $163K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 281 | $394K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 281 | — |
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.