| 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. | $35K | — | $35K | 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 | $8K | $27K | 21.16% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH, INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $21K | $6K | $27K | 26.05% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH, INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | $7K | $22K | 21.63% |
| FMLA SOURCE INC5 Filed as: FMLA SOURCE INC. | 455 N CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $9K | $9K | 8.87% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH, INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 6.61% |
| LAVADA LYNN SCARLETT3 Filed as: LAVADA SCARLETT | 3619 SHADY OAK TRAIL GAINESVILLE, GA 30506 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 7.46% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 6.71% |
| MARIA RADCLIFFE3 | 3317 GREEN FARM TRAIL DACULA, GA 30019 | CONTINENTAL AMERICAN INSURANCE COMPANY | $573 | — | $573 | 1.21% |
| WILLIAM WARDLAW JR3 Filed as: WILLIAM WARDLAW JR. | 187 SOUTH CULVER STREET LAWRENCEVILLE, GA 30046 | CONTINENTAL AMERICAN INSURANCE COMPANY | $363 | — | $363 | 0.76% |
| GLORIA E CAMP3 Filed as: GLORIA CAMP | 235 CAMP CREEK ROAD TOCCOA, GA 30577 | CONTINENTAL AMERICAN INSURANCE COMPANY | $267 | — | $267 | 0.56% |
| COLLEEN M KIRKLAND3 Filed as: COLLEEN KIRKLAND | 11050 CRABAPPLE RD, STE C107 ROSWELL, GA 30075 | CONTINENTAL AMERICAN INSURANCE COMPANY | $264 | — | $264 | 0.56% |
| EDWIN IVEY3 | 986 GREEN STREET CIRCLE GAINESVILLE, GA 30501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $82 | — | $82 | 0.17% |
| CHAMPION BENEFITS3 Filed as: CHAMPION BENEFITS APPROACH INC. | 1455 LINCOLN PARKWAY, SUITE 100 ATLANTA, GA 30346 | METLIFE LEGAL PLANS | $870 | $28 | $898 | 10.30% |
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 | 485 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 490 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 750 | $346K |
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. | 750 | $346K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 472 | $152K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 472 | $102K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 463 | $129K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 472 | $104K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 750 | — |
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.