No insurance carriers on this filing. Self-funded welfare plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STEPHEN HENSON EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $137K |
| BILLY HODGES EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $73K |
| RICHARD DUNCAN EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $71K |
| SANDRA KIDD EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $63K |
| RANDALL RICKMAN EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $63K |
| RICKY FARNER EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $59K |
| MARIO CRUZ EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $56K |
| JAMES ETHERTON EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $53K |
| RODNEY BRICE EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $52K |
| JOE DABON EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $51K |
| JOE PANKEY EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVENDR STONE MOUNTAIN, GA 30083 | $50K |
| ROBERT KELLY EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $49K |
| LISA POLK EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $47K |
| JAMES TOOMEY EIN 58-6112929 EMPLOYEE | Employee (plan) Service code 30 | 1624 ROADHAVEN DR STONE MOUNTAIN, GA 30083 | $45K |
| TED SOILEAU CPA LLC EIN 45-1621265 FUND AUDITOR | Accounting (including auditing) Service code 10 | 2133 SILVERSIDE DR, SUITE C BATON ROUGE, LA 70808 | $36K |
| JENKINS AND ASSOCIATES EIN 58-1596154 FUND ADMINISTRATOR | Contract Administrator Service code 13 | P.O. BOX 607 JONESBORO, GA 30237 | $17K |
| BRANSTETTER KILGORE STRANCH JENNING EIN 62-0513048 ATTORNEY | Legal Service code 29 | 223 ROSA L. PARKS AVENUE NASHVILLE, TN 37203 | $10K |
| MOSE SHELTON EIN 58-6112929 NONE | Other services Service code 49 | 2518 HABERSHAM DR. DECATUR, GA 30032 | $8K |
| UBS FINANCIAL SERIVICES EIN 13-2638116 INVESTMENT CUSTODIAN | Investment advisory (plan) Service code 27 | 3102 WEST END AVENUE, SUITE 500 NASHVILLE, TN 37203 | $6K |
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 | 4,200 | 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) | 4,200 | Active + retired/separated + beneficiaries. No dependents. |
No Schedule A insurance contracts on this filing — typical of fully self-funded plans, where the only headcount is the Form 5500 number above.
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."
No prospect flags tripped on this filing.