| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER & CO | PO BOX 70 WEST POINT, GA 31833 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $62K | — | $62K | 8.32% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J SMITH LANIER & CO | PO BOX 70 WEST POINT, GA 31833 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $84K | — | $84K | 12.42% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J. SMITH LANIER & CO | PO BOX 70 WEST POINT, GA 31833 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $42K | — | $42K | 8.33% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL LIFE & ACC INS CO - ATTACH | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INS CO | $100K | $46K | $146K | 54.66% |
| CHERYL DAGATA DBA CAD & JAD CONSULT4 Filed as: CHERYL DAGATA DBA JAD CLTG SRVCS | 511 ANTHONY PL CANTON, GA 30114 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $10K | — | $10K | 12.42% |
| TOM EATON4 | 128 HOWELL DR CANTON, GA 30115 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $10K | — | $10K | 12.03% |
| KENNETH M CAMPBELL4 | 90 W TURNER AVE ROSELLE, IL 60172 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $90 | — | $90 | 0.11% |
| VICKIE E WEAVER4 | 7701 PEDIGO RD KNOXVILLE, TN 37938 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $15 | — | $15 | 0.02% |
| PLATINUM PROTECTIVE SOLUTIONS LLC4 | PO BOX 2256 ORANGE PARK, FL 32067 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $12 | — | $12 | 0.01% |
| CHARLES SIMMONDS4 | PO BOX 25014 FAYETTEVILLE, NC 28314 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $12 | — | $12 | 0.01% |
| THE PAUL REVERE LIFE INSURANCE3 Filed as: PAUL REVERE LIFE INS - SEE ATTACHED | P.O. BOX 1365 COLUMBIA, SC 29202 | PAUL REVERE LIFE INS CO | $584 | $80 | $664 | 51.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 ASO HLTH PROVIDER | Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Float revenue; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.4M |
| J SMITH LANIER & CO BROKER | Non-monetary compensation; Other commissions Service code 55 | PO BOX 70 WEST POINT, GA 31833 | $320K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $131K |
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 | 8,141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 21 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 8,162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 6,291 | $673K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 2,584 | $506K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 2,793 | $740K |
| Other(4 contracts, 4 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 6,291 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,291 | — |
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.