| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | $36K | — | $36K | 10.00% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH, INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $19K | $9K | $28K | 21.74% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH, INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | $7K | $23K | 21.59% |
| FMLA SOURCE INC5 Filed as: FMLA SOURCE INC. | 455 N CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $21K | $21K | 19.53% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH, INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $20K | $8K | $27K | 27.79% |
| LAVADA LYNN SCARLETT3 Filed as: LAVADA SCARLETT | 3619 SHADY OAK TRAIL GAINESVILLE, GA 30506 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7K | — | $7K | 12.67% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 7.39% |
| GLORIA E CAMP3 Filed as: GLORIA CAMP | 235 CAMP CREEK ROAD TOCCOA, GA 30577 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 6.88% |
| WILLIAM WARDLAW JR3 Filed as: WILLIAM WARDLAW JR. | 187 SOUTH CULVER STREET LAWRENCEVILLE, GA 30046 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 2.50% |
| MARIA RADCLIFFE3 | 3317 GREEN FARM TRAIL DACULA, GA 30019 | CONTINENTAL AMERICAN INSURANCE COMPANY | $578 | — | $578 | 1.11% |
| ASHLEY N GALLOWAY3 Filed as: ASHLEY GALLOWAY | 434 TIMBER COURT CLARKESVILLE, GA 30523 | CONTINENTAL AMERICAN INSURANCE COMPANY | $59 | — | $59 | 0.11% |
| EDWIN IVEY3 | 986 GREEN STREET CIRCLE GAINESVILLE, GA 30501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $53 | — | $53 | 0.10% |
| DENNIS M COPLAND3 Filed as: DENNIS COPLAND | 10300 NORTH CENTRAL EXPRESS WAY DALLAS, TX 75231 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| NANCY E ODOM3 Filed as: NANCY ODOM | 5921 STONE MEADOW DRIVE PLANO, TX 75093 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH, INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 6.72% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | HYATT LEGAL PLANS | $753 | — | $753 | 8.86% |
No Schedule C service providers reported on this filing.
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 | 493 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 501 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 762 | $360K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 762 | $360K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 481 | $148K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 481 | $108K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 481 | $128K |
| Other(3 contracts, 3 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 481 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 762 | — |
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.