| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 3475 PIEDMONT ROAD SUITE 800 ATLANTA, GA 30305 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $35K | $0 | $35K | 4.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 3475 PIEDMONT RD NE SUITE 800 ATLANTA, GA 30305 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $0 | $3K | 4.69% |
| PEARLEAN WASHINGTON3 | 2518 DULUTH HWY 120 STE 202 DULUTH, GA 30097 | AFLAC | $3K | $330 | $4K | 6.19% |
| GEORGE LEE WASHINGTON3 | 2518 DULUTH HWY 120 STE 202 DULUTH, GA 30097 | AFLAC | $3K | $52 | $3K | 4.58% |
| MRS JACKSON BOYUM3 | 2040 SKYLAR LEIGH DR BUFORD, GA 30518 | AFLAC | $730 | $64 | $794 | 1.30% |
| RONALD E KIRKLAND3 | 1044 HARBOR RIDGE RD GUNTERSVILLE, AL 35976 | AFLAC | $486 | $72 | $558 | 0.91% |
| MARIAN HORNE3 | PO BOX 1607 SNELLVILLE, GA 30078 | AFLAC | $541 | $0 | $541 | 0.88% |
| JARRED D WASHINGTON3 | 3395 LAWRENCEVILLE HWY LAWRENCEVILLE, GA 30044 | AFLAC | $341 | $0 | $341 | 0.56% |
| WILLIAM M WARDLAW JR3 | 5300 OAKBROOK PKWY BLDG 300 STE 350 NORCROSS, GA 30093 | AFLAC | $261 | $0 | $261 | 0.43% |
| SCOTT A SMITH3 | 5300 OAKBROOK PRWY BLDG 300 STE 350 NORCROSS, GA 30093 | AFLAC | $184 | $72 | $256 | 0.42% |
| TONYA V MEYER3 | 4705 GUILFORD FOREST DR SW ATLANTA, GA 30331 | AFLAC | $180 | $0 | $180 | 0.29% |
| LARRY W FLOWERS3 | 2318 PROVINCIAL POINT DR GAINESVILLE, GA 30501 | AFLAC | $109 | $0 | $109 | 0.18% |
| VANCE C SMITH III3 | 5300 OAKBROOK PKWY BLDG 300 STE 350 NORCROSS, GA 30093 | AFLAC | $89 | $13 | $102 | 0.17% |
| THOMAS ROBERT GIDDENS3 | PO BOX 2517 KENNESAW, GA 30156 | AFLAC | $101 | $0 | $101 | 0.17% |
| IVAN S WASHINGTON3 | PO BOX 2134 STONE MOUNTAIN, GA 30086 | AFLAC | $61 | $0 | $61 | 0.10% |
| JUDIETTE RODGERS3 | 205 BUTTERFIELD LN FAYETTEVILLE, GA 30214 | AFLAC | $55 | $0 | $55 | 0.09% |
| ELENI A NIKOLAS3 Filed as: ELENI A KRAUSE | 50 HURT PLZ SE STE 995 ATLANTA, GA 30303 | AFLAC | $37 | $3 | $40 | 0.07% |
| ANSON S RAMSEY3 | 540 POWDER SPRINGS ST UNIT B 7 MARIETTA, GA 30064 | AFLAC | $37 | $0 | $37 | 0.06% |
| R STEVEN BURROUGHS3 | 2164 WHITEHALL DR NE MARIETTA, GA 30066 | AFLAC | $35 | $0 | $35 | 0.06% |
| ANN BLAKE BOSWELL3 | 910 WOLF SPRINGS CV LAWRENCEVILLE, GA 30043 | AFLAC | $35 | $0 | $35 | 0.06% |
| ROBYN M ROBERTS3 | 3340 PEYTON DR MONROE, GA 30656 | AFLAC | $30 | $0 | $30 | 0.05% |
| PAT STALLARD INC3 | 6738 HOLIDAY PT BUFORD, GA 30518 | AFLAC | $27 | $0 | $27 | 0.04% |
| LORI J THOMPSON3 | 625 HARBOR POINT CT LAWRENCEVILLE, GA 30044 | AFLAC | $22 | $0 | $22 | 0.04% |
| RAYMOND L MELVIN3 | 1553 NAVIGATOR CIRCLE DACULA, GA 30019 | AFLAC | $20 | $0 | $20 | 0.03% |
| JOHN DALLAS BYERS3 | 2477 TITANS LN BRENTWOOD, TN 37027 | AFLAC | $15 | $0 | $15 | 0.02% |
| MULTIPLE BENEFITS CORPORATION3 | PO BOX 1205 LAWRENCEVILLE, GA 30046 | AFLAC | $15 | $0 | $15 | 0.02% |
| DORIS L BRACKETT3 | 3233 HIGHGATE CHASE CT BERKELEY LAKE, GA 30092 | AFLAC | $14 | $0 | $14 | 0.02% |
| LONNIE R VOGLER3 | 5388 E MOUNTAIN ST STONE MOUNTAIN, GA 30083 | AFLAC | $12 | $0 | $12 | 0.02% |
| PAUL SHELBY AMOS II3 | 1932 WYNNTON RD 14TH FLOOR COLUMBUS, GA 31999 | AFLAC | $9 | $0 | $9 | 0.01% |
| SAMANTHA LYNN WINNINGHAM3 | 3134 HUNT RD ACWORTH, GA 30102 | AFLAC | $8 | $0 | $8 | 0.01% |
| DAVID C CLOUD JR3 | 1301 SHILOH RD NW STE 1020 KENNESAW, GA 30144 | AFLAC | $5 | $0 | $5 | 0.01% |
| MARK S LEE3 | 1192 PEYTON DRIVE NW KENNESAW, GA 30152 | AFLAC | $2 | $0 | $2 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 3475 PIEDMONT ROAD SUITE 800 ATLANTA, GA 30305 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $0 | $3K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 25 BULL STREET 4TH FLOOR SAVANNAH, GA 31401 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 13.96% |
| THE MATHIS-HILL-ROBERTSON AGENCY3 | 5040 ROSWELL RD STE 100 ATLANTA, GA 30342 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $61 | $0 | $61 | 0.28% |
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 | 102 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 93 | $65K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 106 | $28K |
| Short-term disability | AFLAC | 55 | $61K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 46 | $22K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 106 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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.