| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOLMES SHAW INC3 Filed as: THE HOLMES/SHAW AGENCY | 2860 JOHNSON FERRY RD STE 200 MARIETTA, GA 30062 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $0 | $14K | 16.31% |
| HOLMES SHAW INC3 Filed as: THE HOLMES/SHAW AGENCY | 2860 JOHNSON FERRY RD SUITE 200 MARIETTA, GA 30062 | BLUE CROSS AND BLUE SHIELD OF GEORGIA (G0385) | $3K | $0 | $3K | 12.46% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $923 | $0 | $923 | 7.07% |
| JAMES D U SRY3 Filed as: JAMES D USRY | P O BOX 393 THOMSON, GA 30824 | AFLAC | $224 | $0 | $224 | 1.72% |
| DANIEL FITZGERALD INC3 | 3672 BAY PT AUGUSTA, GA 30907 | AFLAC | $126 | $0 | $126 | 0.97% |
| TODD BROOME3 Filed as: TODD S BROOME | P O BOX 6812 AUGUSTA, GA 30916 | AFLAC | $95 | $0 | $95 | 0.73% |
| FRANCINE A CHRISTIANSON3 | P O BOX 7251 MACON, GA 31209 | AFLAC | $72 | $0 | $72 | 0.55% |
| JAMES DAVIS3 Filed as: JAMES E DAVIS | 1506 KLONDIKE RD SW SUITE 100 CONYERS, GA 30094 | AFLAC | $68 | $0 | $68 | 0.52% |
| LORRI STEMBRIDGE LLC3 | 5144 OAKTREE DR MACON, GA 31210 | AFLAC | $35 | $0 | $35 | 0.27% |
| BRENDA WALTON HALL3 | 71 FOX GLOVE CT CATAULA, GA 31804 | AFLAC | $31 | $0 | $31 | 0.24% |
| ROBERT P FERRONE3 Filed as: ROBERT C MOBLEY | 7139 BROAD RIVER RD IRMO, SC 29063 | AFLAC | $27 | $0 | $27 | 0.21% |
| MICHAEL P VENEZIANI3 | 1017 WHITESVILLE WALK DR COLUMBUS, GA 31904 | AFLAC | $24 | $0 | $24 | 0.18% |
| CINDY WILLIAMS3 Filed as: CINDY T WILLIAMS | 1600 HADLEY ROAD PINE MOUNTAIN, GA 31822 | AFLAC | $20 | $0 | $20 | 0.15% |
| JOHN B COLLINS3 | 311 PEBBLE HOLLOW DR MILLEDGEVILLE, GA 31061 | AFLAC | $18 | $0 | $18 | 0.14% |
| E L TAYLOR3 | 756 NEW RUCKERSVILLE RD ELBERTON, GA 30635 | AFLAC | $13 | $0 | $13 | 0.10% |
| KATHY B MOBLEY3 | 173 WAVERLY CIRCLE WAVERLY HALL, GA 31831 | AFLAC | $12 | $0 | $12 | 0.09% |
| BRIAN K CHAMBERS3 | 8 NIGHTWIND CT COLUMBUS, GA 31909 | AFLAC | $10 | $0 | $10 | 0.08% |
| KERRY C EZZELL3 | P O BOX 15074 AUGUSTA, GA 30919 | AFLAC | $10 | $0 | $10 | 0.08% |
| BETTY TAYLOR3 Filed as: BETTY W TAYLOR | 4575 BETHANY BOWERSVILLE RD CANON, GA 30520 | AFLAC | $9 | $0 | $9 | 0.07% |
| ALICIA B CLIFTON3 | 3915 HUNTING RIDGE DR SW LILBURN, GA 30047 | AFLAC | $6 | $0 | $6 | 0.05% |
| RICHARD SMITHSON3 | 449 TIMBER PL MILTON, GA 30004 | AFLAC | $5 | $0 | $5 | 0.04% |
| KEITH BELICH3 | 2740 CENTRAL PKWY MONTGOMERY, AL 36106 | AFLAC | $4 | $0 | $4 | 0.03% |
| WILLIAM M WARDLAW JR3 | 5300 OAKBROOK PKWY BLDG 300 STE 350 NORCROSS, GA 30093 | AFLAC | $2 | $0 | $2 | 0.02% |
| RICHARD SMITHSON3 | 2000 BROOKE FOREST CT ALPHARETTA, GA 30022 | AFLAC | $1 | $0 | $1 | 0.01% |
| BONNIE ROWE3 | 916 WATERMARK DR EVANS, GA 30809 | AFLAC | $1 | $0 | $1 | 0.01% |
| SCOTT A SMITH3 | 5300 OAKBROOK PKWY BLDG 300 STE 350 NORCROSS, GA 30093 | AFLAC | $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 | 183 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | BLUE CROSS AND BLUE SHIELD OF GEORGIA (G0385) | 145 | $21K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 192 | $89K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 192 | $89K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 192 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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.