| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 541 NORTH MAIN STREET, SUITE 100 MOUNT AIRY, NC 27030 | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | $107K | — | $107K | 22.36% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | SHARED SERVICES 6000 POPLAR AVE MEMPHIS, TN 38119 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $34K | — | $34K | 12.21% |
| AVERY INSURANCE GROUP INC.3 | 2083 WOODSIDE PARK DR. WOODSTOCK, GA 30076 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $21K | — | $21K | 7.62% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC | EB COMMISSION P.O. BOX 896620 CHARLOTTE, NC 282896620 | STARMOUNT LIFE INSURANCE COMPANY | $29K | — | $29K | 13.23% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | SHARED SERVICES 6000 POPLAR AVE MEMPHIS, TN 38119 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 16.39% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | P.O. BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $484 | — | $484 | 0.91% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC | SHARED SERVICES 6000 POPLAR AVE MEMPHIS, TN 38119 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 8.31% |
| AVERY INSURANCE GROUP INC.3 | 2083 WOODSIDE PARK DR WOODSTOCK, GA 30076 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.90% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | SHARED SERVICES 6000 POPLAR AVE MEMPHIS, TN 38119 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 14.01% |
| PLANSOURCE BENEFIT ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMINISTRATION, | P.O. BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $554 | — | $554 | 2.00% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES - A | EB COMMISSION PO BOX 89662 GREENSBORO, NC 282896620 | STARMOUNT LIFE INSURANCE COMPANY | $2K | — | $2K | 11.03% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | SHARED SERVICES 6000 POPLAR AVE MEMPHIS, TN 38119 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $858 | — | $858 | 6.39% |
| AVERY INSURANCE GROUP INC.3 Filed as: AVERY INSURANCE GROUP, INC. | 2083 WOODSIDE PARK DR WOODSTOCK, GA 30076 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $600 | — | $600 | 4.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTHCARE P EIN 58-1638390 SELF | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $333K |
| BLUE CROSS BLUE SHIELD HEALTHCARE | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $97K |
| INGENIORX, INC. EIN 82-3062245 SELF | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing Service code 12 | — | -$65K |
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 | 289 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 289 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF HAWAII | 44 | $234K |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF HAWAII | 231 | $456K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF HAWAII | 120 | $248K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $53K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $290K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $277K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | 393 | $477K |
| Other(4 contracts, 2 carriers) | ARMADACARE | 289 | $420K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 393 | — |
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.