| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET BOSTON, MA 02110 | AETNA LIFE INSURANCE CO. | $2K | $0 | $2K | 0.13% |
| ANDERSON CORPORATE SOLUTIONS INC3 | 1735 N BROWN ROAD SUITE 220 LAWRENCEVILLE, GA 30043 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $0 | $9K | 10.00% |
| ANDERSON CORPORATE SOLUTIONS INC3 | 1735 N BROWN ROAD SUITE 220 LAWRENCEVILLE, GA 30043 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $0 | $9K | 15.00% |
| ANDERSON CORPORATE SOLUTIONS INC3 | 1735 N BROWN ROAD SUITE 220 LAWRENCEVILLE, GA 30043 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 15.00% |
| ANDERSON CORPORATE SOLUTIONS INC3 | 1735 N BROWN ROAD SUITE 220 LAWRENCEVILLE, GA 30043 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 15.00% |
| KAREN H SMITH3 | 145 CHURCH STREET NE SUITE 200 MARIETTA, GA 30060 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9K | $0 | $9K | — |
| FRAN C HARGARTEN III3 | 1140 MOSSY ROCK ROAD NW KENNESAW, GA 30152 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | $0 | $2K | — |
| JOHN P KOWN II3 | 1275 SHILOH ROAD SUITE 2260 KENNESAW, GA 30144 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | $0 | $1K | — |
| ANDREW D KOWN3 | 710 CREEKGARDEN COURT ATLANTA, GA 30339 | CONTINENTAL AMERICAN INSURANCE COMPANY | $139 | $0 | $139 | — |
| ADAM T HARRIS3 | 126 HIDDEN LAKE CIRCLE CANTON, GA 30114 | CONTINENTAL AMERICAN INSURANCE COMPANY | $120 | $0 | $120 | — |
| RONALD S SANDERS3 | 1194 E LAKEVIEW DRIVE SAN TAN VALLEY, AZ 85143 | CONTINENTAL AMERICAN INSURANCE COMPANY | $82 | $0 | $82 | — |
| DAVID C CLOUD JR3 Filed as: DAVID C CLOUD | 89 GEMSTONE LANE ACWORTH, GA 30101 | CONTINENTAL AMERICAN INSURANCE COMPANY | $23 | $0 | $23 | — |
| CHARLES S MADISON3 | 3303 COBB PKWY NW SUITE 324-354 ACWORTH, GA 30101 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | $0 | $12 | — |
| RICHARD MICHAEL TIDWELL3 Filed as: RICHARD M TIDWELL | PO BOX 1801 CUMMING, GA 30028 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | $0 | $8 | — |
| RYAN E MCPHAIL3 | 206 ARBOR COURT CANTON, GA 30114 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | $0 | $8 | — |
| DUSTIN ROBERT JOHNSON3 Filed as: DUSTIN R JOHNSON | 50 HURT PLAZA SE SUITE 995 ATLANTA, GA 30306 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | $0 | $8 | — |
| AMY A O SHIELDS3 Filed as: AMY A O'SHIELDS | 5159 CALGARY DRIVE DOUGLASVILLE, GA 30135 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | $0 | $6 | — |
| ALEXANDER B WARD3 | 5194 FOREST VIEW COURT SE MABLETON, GA 30126 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5 | $0 | $5 | — |
| STEVEN VORDERLANDWEHR3 | 2219 MCCAHILL COURT BUFORD, GA 30519 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4 | $0 | $4 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| RSC INSURANCE BROKERAGE INC BROKER | Insurance agents and brokers Service code 22 | 160 FEDERAL STREET BOSTON, MA 02110 | $55K |
| ADMIN AMERICA HRA ADMIN | Claims processing; Plan Administrator Service code 12 | 1720 WINDWARD CONCOURSE SUITE 290 ALPHARETTA, GA 30005 | $8K |
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 | 238 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 239 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 374 | $1.6M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 180 | $92K |
| Vision | AETNA LIFE INSURANCE CO. | 374 | $1.6M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $59K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 160 | $34K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $41K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 374 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.