| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP, INC. | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $13K | $83K | $96K | 3.58% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP, INC. | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $47K | — | $47K | 4.60% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP, INC. | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | KAISER FOUNDATION HEALTH PLAN INC | $13K | — | $13K | 4.61% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP, INC. | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | GROUP HEALTH COOPERATIVE | $8K | — | $8K | 5.39% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | KAISER FOUNDATION HEALTH PLAN, INC | $4K | — | $4K | 4.42% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | — | $15K | 15.40% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP | 3060 PEACHTREE ROAD SUITE 1650 ATLANTA, GA 30305 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | — | $15K | 15.40% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 19.90% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP | 3060 PEACHTREE ROAD, NW SUITE 1650 ATLANTA, GA 30305 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 14.59% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP INC | 3060 PEACHTREE RD ATLANTA, GA 30305 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $625 | — | $625 | 12.53% |
| KLD INSURANCE BENEFITS INC3 | 8045 ROYAL SAINT GEORGES LANE DULUTH, GA 30097 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $198 | $204 | $402 | 8.06% |
| ASSUREDPARTNERS3 Filed as: JENNIFER ROSE SMITH | 4920 W SAN RAFAEL ST TAMPA, FL 33629 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $203 | $47 | $250 | 5.01% |
| NORMAC SOLUTIONS INC3 | 3730 EVEREST DR MONTGOMERY, AL 36106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $146 | $39 | $185 | 3.71% |
| KLINGBEIL AND ASSOCIATES INC3 | 6000 LAKE FORREST DRIVE ATLANTA, GA 30328 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $39 | $79 | 1.58% |
| CAROLE H WARREN3 | 1300 27TH PLACE SOUTH BIRMINGHAM, AL 35205 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $57 | $14 | $71 | 1.42% |
| LAURIE J BURNS3 | 303 PLYLER RD INDIAN TRAIL, NC 28079 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $11 | $51 | 1.02% |
| KEVIN LEE SURLES SR3 | 1054 VILLA MARIA COURT SAN JOSE, CA 95125 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | — | $40 | 0.80% |
| NORTH FLORIDA BROKER SOLUTIONS LLC3 | 1550 HARRINGTON PARK DRIVE JACKSONVILLE, FL 32225 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $19 | $34 | 0.68% |
| ANNALIESE CLARK3 | 1336 HIDEAWAY DR S SAINT JOHNS, FL 32259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $4 | $19 | 0.38% |
| CLAUDIA MARABOTO3 | 130 TIERRA MONTANOSA RANCHO SANTO MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.18% |
| JOHN D EVANGELISTA3 | 29811 SANTA MARGARITA PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.04% |
| FALLON BENEFITS GROUP INC.3 Filed as: FALLON BENEFITS GROUP INC | 3060 PEACHTREE RD ATLANTA, GA 30305 | THE PAUL REVERE LIFE INSURANCE COMPANY | $149 | — | $149 | 24.51% |
| KIMANI MATTHEW3 | 1113 EAST 212TH ST BRONX, NY 10469 | THE PAUL REVERE LIFE INSURANCE COMPANY | $55 | $33 | $88 | 14.47% |
| KLD INSURANCE BENEFITS INC3 Filed as: KLD INSURANCE BENEFITS | 8045 ROYAL SAINT GEORGES LANE DULUTH, GA 30097 | THE PAUL REVERE LIFE INSURANCE COMPANY | $38 | $13 | $51 | 8.39% |
| ABRAHAM OYEWO3 | 1039 EAST 227 STREET BRONX, NY 10466 | THE PAUL REVERE LIFE INSURANCE COMPANY | $36 | $7 | $43 | 7.07% |
| HOWARD HOROWITZ3 Filed as: HOWARD P DILEMA | 50 MAIN ST WHITE PLAINS, NY 10606 | THE PAUL REVERE LIFE INSURANCE COMPANY | $11 | $12 | $23 | 3.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 PROVIDE CLAIMS ADMIN | Claims processing; Contract Administrator; Float revenue; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan; Other services Service code 12 | — | $18K |
| LIFE INSURANCE COMPANY OF NORTH AME EIN 23-1503749 PROVIDE STD CLAIMS ADMIN | Direct payment from the plan; Float revenue; Other services; Contract Administrator; Participant communication; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $10K |
| CIGNA | Other services; Float revenue; Contract Administrator; Named fiduciary; Non-monetary compensation; Claims processing; Participant communication; Direct payment from the plan Service code 12 | — | $0 |
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 | 463 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 481 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 388 | $2.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 388 | $2.7M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 388 | $2.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 463 | $96K |
| Short-term disability | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 65 | $3K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 463 | $95K |
| Other(5 contracts, 5 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 479 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 479 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.