Form 5500 · Employee benefit plan · FOREST PARK, GA
MID-SOUTH SUBCONTRACTORS INC MID-SOUTH ROOF SYSTEMS
The filing calls this plan MID-SOUTH ROOF SYSTEMS WELFARE PLANS.
MID-SOUTH SUBCONTRACTORS INC MID-SOUTH ROOF SYSTEMS of FOREST PARK, GA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is SCHKABLA LLC. Coverage is written through BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 58-1876904 · plan 501 · plan year 2025, filed Jun 5, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC., covers 319 people.
Reported premium across the insured contracts is $2,082,526, with $129,499 in disclosed broker commissions — about 6.2% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
SCHKABLA LLC is the broker of record on all 3 contracts.
Two carriers split the book: BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. and UNITED OF OMAHA LIFE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | Health, Dental, Vision | 319 | Jan 1, 2026 | $1,984,122 | $114,739 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 91 | Jan 1, 2026 | $50,476 | $7,571 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 56 | Jan 1, 2026 | $47,928 | $7,189 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 190 employees, 1 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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