| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 400 INTERSTATE NORTH PKWY SE STE 600 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $3K | $15K | 15.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.16% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 400 INTERSTATE NORTH PKWY SE STE 60 ATLANTA, GA 30339 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $217 | $2K | 12.17% |
| KLD INSURANCE BENEFITS INC3 Filed as: KLD INS BENEFITS INC | 9085 BETHEL RD GAINESVILLE, GA 30506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $813 | $474 | $1K | 9.72% |
| DANA MARIE MOWATT3 | 23701 S WESTERN AVE SPC 112 TORRANCE, CA 90501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $488 | $97 | $585 | 4.42% |
| CHRISTY O. CHRISTIAN3 Filed as: CHRISTY O CHRISTIAN | 6235 BUCKINGHAM CIR CUMMING, GA 30040 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $192 | $0 | $192 | 1.45% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $81 | $58 | $139 | 1.05% |
| C ADAMS VOLK3 | 2295 OLD ORCHARD DR MARIETTA, GA 30068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $71 | $0 | $71 | 0.54% |
| EMILY PORRECA3 | 146 WINDFIELDS LN WOODSTOCK, GA 30188 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | $0 | $43 | 0.32% |
| MONICA M DEAN3 | 1855 EVERGREEN LN ALPHARETTA, GA 30009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | $0 | $41 | 0.31% |
| TULLY AND COMPANY INC3 | 1926 STONE BRIDGE LN MARIETTA, GA 30064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $0 | $27 | 0.20% |
| JENNIFER E LUBELSKY3 | 80 JOHN ST APT 11C NEW YORK, NY 10038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $2 | $20 | 0.15% |
| CINDY L WOOD3 | 5215 BLUE RIDGE OVERLOOK DAWSONVILLE, GA 30534 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $3 | $17 | 0.13% |
| ELIZABETH LOUISE FENDER3 | 335 S EMERSON AVE INDIANAPOLIS, IN 46219 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.11% |
| WALTER THOMAS BONILLA3 | 9 LONGLEAF LN MEDFORD, NY 11763 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.03% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA RD UNIT 2367 OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
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 | 132 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $100K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $100K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $100K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 101 | $511K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 132 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.