Workers’ Compensation Submission Summary
Sample Report: This is a fictional sample report prepared for demonstration purposes only.
It shows how ACORD 130/e-form data, applicant-provided information, AI-assisted business research, and publicly available online information can be organized into a professional carrier-facing workers’ compensation submission summary.
This report is based on applicant-provided ACORD 130-style information, supporting documents if provided, and publicly available information reviewed as of the report date.
Manual rates and manual premium calculations are intentionally excluded. Detailed loss analysis is not included unless actual loss runs are provided.
1. Introduction to Underwriter
Southern Grace Home Care & Senior Services, LLC is presented for workers’ compensation review as an established Georgia-based senior care organization with a reported business start date of 07/15/2016. The applicant operates from three Georgia locations and reports operations concentrated within non-medical home care, companion care, personal care assistance, respite care, client transportation assistance, assisted living, and memory care services.
The submission includes organized payroll by workers’ compensation class code, employee count by full-time and part-time status, officer information, location information, prior insurance history, vehicle/driver information, licensing-style information, job posting research, online business profile details, and public record summaries.
The reported current experience modification factor is 0.98. The applicant also reports safety and operational practices including new hire training, annual caregiver training, patient transfer training, driver MVR checks, a drug-free workplace program, accident investigation, quarterly safety meetings, and return-to-work procedures.
Public-facing information reviewed for this sample, including corporate filing information, website content, online business profiles, job posting activity, licensing-style records, and location research, appears generally consistent with the applicant’s reported operations. The account presents a defined and understandable workers’ compensation exposure with identified locations, officers, payroll categories, employee groups, and business operations.
2. Account Snapshot
0.98
Reported Experience Mod
| Field |
Sample Information |
| Applicant |
Southern Grace Home Care & Senior Services, LLC |
| DBA |
Southern Grace Home Care |
| Mailing Address |
1200 Palmyra Road, Suite 200, Albany, GA 31701 |
| Phone |
229-555-0184 |
| Website |
www.southerngracehomecare.com |
| FEIN |
XX-XXX4821 |
| Entity Type |
Limited Liability Company |
| Date Business Started |
07/15/2016 |
| Governing State |
Georgia |
| States of Operation |
Georgia |
| Requested Policy Term |
04/01/2026 to 04/01/2027 |
| Reported Annual Payroll |
$2,000,000 |
| Reported Experience Mod |
0.98 |
| Prior Carrier |
PeachState Casualty Insurance Company |
| Expiring Premium |
$79,600 |
3. Public Record Snapshot
| Area Reviewed |
Sample Result |
| Corporate Status |
Active / Compliant in sample Georgia Secretary of State-style search. |
| Business Continuity |
Reported business start date, entity formation date, and sample licensing issue dates support continued operations since 2016. |
| Bankruptcy |
No active bankruptcy record identified in sample search. |
| OSHA |
No OSHA inspection activity identified in sample search. |
| DOT / FMCSA |
No USDOT profile identified in sample search. |
| Licensing |
Sample home care, assisted living, and memory care license records shown as active. |
| Online Reviews |
Generally favorable public review presence in sample online profile search. |
4. Submission Strengths
- Clear business description provided through ACORD 130-style information.
- Reported operations are supported by website and public business profile information.
- Payroll is broken out by class code and operational function.
- Employee count is broken out by full-time and part-time status.
- Employee count percentages are shown by class code.
- Locations are identified, mapped, and summarized with local operating context.
- Officer and ownership information is provided.
- Prior insurance history and reported experience mod are provided.
- Public corporate filing information supports business continuity.
- Licensing-style information supports reported senior care operations.
- Job postings support reported employee duties and operational categories.
- Applicant-reported safety practices are identified and summarized.
5. Operations Consistency Summary
| Source |
Operations Indicated |
Consistency With Submission |
| ACORD 130 / E-Form |
Home care, companion care, personal care, assisted living, memory care, limited transportation assistance. |
Consistent |
| Company Website |
Personal care, respite care, dementia care, transportation assistance, care coordination, memory care. |
Consistent |
| Job Postings |
Caregivers, memory care aides, care coordinators, transportation aide, resident care supervisor. |
Consistent |
| Licensing-Style Search |
Private home care provider, assisted living community, memory care endorsement. |
Consistent |
| Google Business Profile |
Senior care / home care services. |
Consistent |
| NAICS / SIC Indicators |
Home health care, assisted living, elderly services, personal care facilities. |
Consistent |
The applicant-provided ACORD 130-style information, company website, online business profiles, licensing-style information, job posting activity, Google location information, and industry code indicators support a consistent business profile focused on senior care, non-medical home care, assisted living, memory care, care coordination, and limited transportation assistance.
6. Entity Match Verification
| Match Indicator |
Sample Result |
| Legal Name Match |
Yes — Southern Grace Home Care & Senior Services, LLC. |
| DBA Match |
Yes — Southern Grace Home Care. |
| Primary Address Match |
Yes — 1200 Palmyra Road, Suite 200, Albany, GA 31701. |
| Phone Match |
Yes — sample public profile phone aligns with applicant-provided phone. |
| Website Match |
Yes — sample website aligns with applicant-provided business name and operations. |
| Officer / Registered Agent Match |
Yes — Mary Thompson appears as managing member / registered agent in sample information. |
| Business Category Match |
Yes — public-facing categories align with senior care and home care services. |
7. Business Overview
Southern Grace Home Care & Senior Services, LLC provides non-medical in-home senior care services including companion care, personal assistance, bathing and grooming assistance, meal preparation, medication reminders, respite care, transportation assistance, dementia support, and post-hospital discharge support.
The company also operates a small assisted living and memory care residence in Americus, Georgia. Applicant-provided information and public-facing website content describe a business focused on serving elderly clients, individuals needing daily living assistance, and families seeking in-home or residential care support.
8. Business Continuity Indicators
| Indicator |
Sample Information |
| Business Start Date Reported |
07/15/2016 |
| Entity Formation Date |
07/15/2016 |
| Private Home Care License Issue Date |
08/01/2016 |
| Assisted Living License Issue Date |
11/15/2019 |
| Locations Reported |
3 Georgia locations. |
| Online Review Presence |
Multiple public review/profile sources identified in sample search. |
| Current Job Posting Activity |
Caregiver, memory care aide, care coordinator, and transportation-related roles identified in sample job posting review. |
9. Online Presence and Business Profiles
| Online Source |
Profile / Link |
Sample Information Found |
| Company Website |
www.southerngracehomecare.com |
Website describes home care, personal care, companion care, respite care, dementia support, transportation assistance, and assisted living/memory care services. |
| Google Business Profile |
Google Business Search |
Business category and listed location information are consistent with senior care/home care operations. |
| Facebook |
Facebook Profile Search |
Public-facing social profile content includes family-oriented care messaging, caregiver highlights, and community engagement. |
| LinkedIn |
LinkedIn Company Search |
Company profile information may support employee count, hiring activity, business description, and key personnel. |
| Indeed |
Indeed Job Search |
Job posting activity supports staffing needs, employee duties, wage ranges, and operational functions. |
| BBB |
BBB Search |
BBB-style profile information may support reputation, complaint history, business category, and length of operation. |
| Caring.com |
Caring.com Search |
Senior-care-specific review sites may provide additional public reputation and service information. |
10. ACORD 130-Style Operations Information
| Category |
Applicant-Provided Information |
| Description of Operations |
Non-medical home care, companion care, personal care assistance, medication reminders, client transportation, case management, and small assisted living/memory care facility. |
| Employee Leasing / PEO |
No |
| Subcontractors / 1099 Labor |
Applicant reports no 1099 caregivers. |
| Seasonal Operations |
No significant seasonality reported. |
| Volunteers |
No volunteers reported. |
| Foreign Travel |
No foreign travel reported. |
| Out-of-State Work |
No regular out-of-state work reported. |
| Company Vehicles |
5 company-owned vehicles reported. |
| Employee-Owned Vehicles Used |
Yes, caregivers may use personal vehicles for client visits. |
| Client Transportation |
Yes, limited transportation assistance reported. |
11. State Exposure Summary
| Field |
Sample Information |
| Governing State |
Georgia |
| Policy States Reported |
Georgia |
| Known Operating Locations |
Albany, Leesburg, and Americus, Georgia. |
| Out-of-State Work Reported |
No regular out-of-state work reported. |
| Foreign Travel Reported |
No foreign travel reported. |
| Primary Service Territory |
Southwest Georgia local/regional service territory. |
12. Officers / Owners
| Officer |
Title |
Ownership % |
Duties |
Reported Payroll |
WC Status Reported |
| Mary Thompson |
CEO / Managing Member |
50% |
Executive management, contracts, community relations. |
$96,200 |
Included |
| James Whitaker |
CFO / Member |
25% |
Finance, payroll, HR oversight. |
$84,000 |
Excluded |
| Angela Reed |
COO / Member |
25% |
Operations, caregiver scheduling, compliance. |
$88,400 |
Included |
Officer / Ownership Summary
| Item |
Value |
| Number of Officers / Members Listed |
3 |
| Total Ownership Represented |
100% |
| Officers Included |
2 |
| Officers Excluded |
1 |
| Total Reported Officer Payroll |
$268,600 |
| Officer Payroll as % of Total Payroll |
13.4% |
13. Locations, Maps, and Community Context
| Location |
Address / Map |
County |
Approx. City Population |
Area Type |
Reported Operations |
| Location 1 |
1200 Palmyra Road, Suite 200, Albany, GA 31701
View on Google Maps
|
Dougherty County |
Approx. 67,000 |
Small city / regional commercial hub |
Administrative office, HR, billing, scheduling, caregiver dispatch, care coordination. |
| Location 2 |
240 Walnut Avenue South, Leesburg, GA 31763
View on Google Maps
|
Lee County |
Approx. 3,500 |
Small town / suburban-rural market |
Satellite office, intake, caregiver scheduling, regional client support. |
| Location 3 |
88 Magnolia Trace Drive, Americus, GA 31709
View on Google Maps
|
Sumter County |
Approx. 16,000 |
Small city / regional rural market |
Assisted living, memory care, personal care, meals, medication assistance. |
The applicant’s locations are positioned across southwest Georgia, with Albany serving as the primary administrative and caregiver dispatch location. Leesburg provides a satellite office presence in Lee County, while Americus supports the company’s assisted living and memory care operations in Sumter County.
The service territory is primarily local/regional, with caregiver travel expected between client homes, office locations, and care-related appointments. No regular out-of-state operations are reported in the sample ACORD 130-style information.
14. Corporate Filing Summary
| Field |
Sample Public Information |
| Legal Name |
Southern Grace Home Care & Senior Services, LLC |
| State of Formation |
Georgia |
| Control Number |
16074291 |
| Formation Date |
07/15/2016 |
| Entity Type |
Domestic Limited Liability Company |
| Status |
Active / Compliant |
| Principal Office |
1200 Palmyra Road, Suite 200, Albany, GA 31701 |
| Registered Agent |
Mary Thompson |
| Last Annual Registration |
02/12/2026 |
15. Website and AI-Assisted Operations Review
| Area Reviewed |
AI-Assisted Summary Based on Public-Facing Information |
| Primary Services |
Companion care, personal care assistance, bathing and grooming assistance, meal preparation, medication reminders, dementia and Alzheimer’s support, respite care, client transportation assistance, post-hospital discharge support, assisted living support, and memory care services. |
| Customer / Client Type |
Elderly clients, individuals requiring daily living assistance, family caregivers seeking respite, and residents of assisted living/memory care setting. |
| Operational Focus |
Public-facing information presents a focused senior care organization rather than a diversified or unrelated business operation. |
| Service Delivery |
Services are delivered through a combination of in-home caregiver visits, care coordination, limited transportation assistance, and facility-based assisted living/memory care operations. |
| Online Consistency |
Website and public profile descriptions appear consistent with applicant-provided ACORD 130-style operations. |
16. NAICS / SIC Summary
| Code Type |
Code |
Description |
Relevance to Reported Operations |
| NAICS |
621610 |
Home Health Care Services |
Consistent with reported in-home care operations. |
| NAICS |
623312 |
Assisted Living Facilities for the Elderly |
Consistent with reported assisted living/memory care residence. |
| NAICS |
624120 |
Services for the Elderly and Persons with Disabilities |
Consistent with non-medical personal care and senior support services. |
| SIC |
8082 |
Home Health Care Services |
General industry match. |
| SIC |
8059 |
Nursing and Personal Care Facilities, NEC |
May be applicable to residential care operations. |
17. Workers’ Compensation Class Code and Payroll Summary
Class codes and payroll amounts shown below are based on the sample ACORD 130-style information provided.
Manual rates and estimated manual premium are not included.
| Class Code |
Description |
Reported Payroll |
% of Total Payroll |
| 8835 |
Home health care / in-home caregivers |
$1,250,000 |
62.5% |
| 8829 |
Assisted living / residential care staff |
$250,000 |
12.5% |
| 8810 |
Clerical office employees |
$250,000 |
12.5% |
| 8742 |
Outside sales / care coordinators |
$150,000 |
7.5% |
| 7380 |
Drivers / client transportation |
$100,000 |
5.0% |
| Total |
$2,000,000 |
100.0% |
Payroll by Class Code
8835 Home Health Care / In-Home Caregivers — $1,250,000
8829 Assisted Living / Residential Care Staff — $250,000
8810 Clerical Office Employees — $250,000
8742 Outside Sales / Care Coordinators — $150,000
7380 Drivers / Client Transportation — $100,000
18. Class Code Support Summary
| Class Code |
Reported Description |
Supporting Information Found |
| 8835 |
Home health care / in-home caregivers |
ACORD operations, website services, caregiver job postings, home care service descriptions. |
| 8829 |
Assisted living / residential care staff |
Americus facility, memory care license-style information, memory care aide postings, residential care services. |
| 8810 |
Clerical office employees |
Albany office, scheduling, HR, billing, administrative functions, office location information. |
| 8742 |
Outside sales / care coordinators |
Care coordinator job postings, intake, family communication, scheduling, care coordination duties. |
| 7380 |
Drivers / client transportation |
ACORD transportation disclosure, transportation aide posting, company vehicles, limited client transportation assistance. |
19. Employee Count Summary by Class Code
| Class Code / Employee Group |
Full-Time |
Part-Time |
Total Employees |
% of Employees |
Reported Payroll |
Payroll Per Employee |
| 8835 — Home Care Field Caregivers |
42 |
37 |
79 |
53.7% |
$1,250,000 |
$15,823 |
| 8829 — Assisted Living / Memory Care Staff |
18 |
20 |
38 |
25.9% |
$250,000 |
$6,579 |
| 8810 — Clerical / Administrative |
14 |
5 |
19 |
12.9% |
$250,000 |
$13,158 |
| 8742 — Outside Sales / Care Coordinators |
4 |
2 |
6 |
4.1% |
$150,000 |
$25,000 |
| 7380 — Drivers / Transportation Aides |
3 |
2 |
5 |
3.4% |
$100,000 |
$20,000 |
| Total |
81 |
66 |
147 |
100.0% |
$2,000,000 |
$13,605 |
Employee Count Percentage by Class Code
8835 Home Care Field Caregivers — 79 employees
8829 Assisted Living / Memory Care Staff — 38 employees
8810 Clerical / Administrative — 19 employees
8742 Outside Sales / Care Coordinators — 6 employees
7380 Drivers / Transportation Aides — 5 employees
20. Full-Time / Part-Time Mix by Class Code
| Class Code / Employee Group |
Full-Time |
Part-Time |
Total |
FT % |
PT % |
| 8835 — Home Care Field Caregivers |
42 |
37 |
79 |
53.2% |
46.8% |
| 8829 — Assisted Living / Memory Care Staff |
18 |
20 |
38 |
47.4% |
52.6% |
| 8810 — Clerical / Administrative |
14 |
5 |
19 |
73.7% |
26.3% |
| 8742 — Outside Sales / Care Coordinators |
4 |
2 |
6 |
66.7% |
33.3% |
| 7380 — Drivers / Transportation Aides |
3 |
2 |
5 |
60.0% |
40.0% |
| Total |
81 |
66 |
147 |
55.1% |
44.9% |
Overall Full-Time vs Part-Time Employee Mix
21. Payroll by Location
| Location |
City |
Reported Payroll |
% of Total Payroll |
| Albany Main Office / Caregiver Dispatch |
Albany, GA |
$1,050,000 |
52.5% |
| Leesburg Satellite Office |
Leesburg, GA |
$400,000 |
20.0% |
| Americus Assisted Living / Memory Care Residence |
Americus, GA |
$550,000 |
27.5% |
| Total |
$2,000,000 |
100.0% |
Payroll by Location Graph
Albany Main Office / Caregiver Dispatch — $1,050,000
Americus Assisted Living / Memory Care Residence — $550,000
Leesburg Satellite Office — $400,000
22. Current and Historical Job Posting Review
Job posting information can help support reported operations, staffing activity, employee duties, wage ranges, and class code context.
This sample section uses fictional job posting findings for demonstration.
| Posting Type |
Location |
Sample Job Title |
FT / PT |
Sample Wage / Schedule |
Duties Indicated |
Supports |
| Current |
Albany, GA |
Personal Care Assistant / Caregiver |
FT/PT |
$14 – $17/hour |
Personal care, companionship, client home visits, meal assistance. |
8835 |
| Current |
Americus, GA |
Memory Care Aide |
FT/PT |
$15 – $18/hour; rotating shifts |
Resident assistance, dementia support, personal care, daily living support. |
8829 |
| Current |
Leesburg, GA |
Care Coordinator |
FT |
$38,000 – $45,000/year |
Scheduling, intake, family communication, care coordination. |
8742 / 8810 |
| Historical |
Albany, GA |
Transportation Aide |
PT |
$16/hour |
Client transportation, appointment support, local driving. |
7380 |
| Historical |
Americus, GA |
Resident Care Supervisor |
FT |
$42,000 – $48,000/year |
Supervision of care staff, resident care oversight, facility support. |
8829 |
Sample current and historical job postings support the applicant’s reported operations, including home care field caregivers, memory care staff, care coordinators, transportation aides, and supervisory care roles. Wage ranges and job duties appear consistent with the applicant’s reported payroll categories and full-time/part-time employee mix.
23. Prior Insurance History
| Policy Term |
Carrier |
Reported Premium |
Reported Losses |
Experience Mod |
| 04/01/2023 – 04/01/2024 |
PeachState Casualty Insurance Company |
$72,500 |
$52,000 |
1.06 |
| 04/01/2024 – 04/01/2025 |
PeachState Casualty Insurance Company |
$76,800 |
$86,000 |
1.02 |
| 04/01/2025 – 04/01/2026 |
PeachState Casualty Insurance Company |
$79,600 |
$78,000 |
0.98 |
Reported Prior Premium History
Reported Experience Mod History
24. Vehicle, Driver, DOT, and Driving Exposure Summary
| Field |
Applicant-Provided / Public Information |
| Company Vehicles |
5 company-owned vehicles reported. |
| Vehicle Types |
Passenger vans and small SUVs reported. |
| Employee-Owned Vehicles Used |
Yes, employees may use personal vehicles for client visits. |
| Client Transportation |
Limited client transportation assistance reported. |
| Driver / Transportation Employees |
5 transportation aides reported in class code 7380 sample payroll grouping. |
| MVR Checks |
Applicant reports annual MVR checks. |
| Driver Training |
Applicant reports driver training at hire. |
| USDOT Number |
No USDOT number identified in sample public search. |
| FMCSA Operating Status |
Not applicable based on sample search. |
| FMCSA Inspections / Crashes |
No FMCSA inspection or crash history identified in sample search because no USDOT profile was identified. |
DOT / FMCSA Search Summary
| Search Item |
Sample Result |
| Legal Name Searched |
No USDOT profile identified in sample search. |
| DBA Searched |
No USDOT profile identified in sample search. |
| Address Searched |
No matching FMCSA profile identified in sample search. |
| USDOT Number |
None identified. |
| MC Number |
None identified. |
| Power Units |
Not applicable. |
| FMCSA Crash History |
Not applicable. |
| FMCSA Inspection History |
Not applicable. |
Driving Territory and Public Roadway Context
| Area |
Driving Context |
Public Data Reference |
| Albany / Dougherty County |
Local city and regional road travel associated with caregiver dispatch, client visits, and administrative operations. |
Georgia Governor’s Office of Highway Safety |
| Leesburg / Lee County |
Small-town and suburban/rural travel associated with satellite office operations and client home visits. |
Georgia DOT Crash Reporting |
| Americus / Sumter County |
Local and regional travel associated with assisted living operations, staffing, and client/family support services. |
Georgia DOT Crash Reporting |
25. OSHA and Workplace Safety Public Record Summary
OSHA Search Method Summary
| Search Item |
Sample Result |
| Legal Name Searched |
No matching OSHA inspection record identified in sample search. |
| DBA Searched |
No matching OSHA inspection record identified in sample search. |
| Primary Address Searched |
No matching OSHA inspection record identified in sample search. |
| Serious / Willful / Repeat Violations |
None identified in sample search. |
| Fatality / Catastrophe Records |
None identified in sample search. |
| Severe Injury Reports |
None identified in sample search. |
Applicant-Reported Safety and Business Practices
| Control Area |
Applicant-Provided Information |
| Written Safety Program |
Yes |
| New Hire Training |
Yes |
| Annual Caregiver Training |
Yes |
| Patient Transfer Training |
Yes |
| Dementia / Behavioral Training |
Yes |
| Driver MVR Checks |
Yes, annually |
| Drug-Free Workplace Program |
Yes |
| Return-to-Work Program |
Yes |
| Accident Investigation |
Yes |
| Safety Meetings |
Quarterly |
| Client Home Safety Checklist |
Yes |
26. Licensing / Regulatory Summary
| License Type |
License Number |
Location |
Issue Date |
Expiration Date |
Status |
| Private Home Care Provider |
PHCP-28741 |
Albany / Leesburg |
08/01/2016 |
08/01/2026 |
Active |
| Assisted Living Community |
ALC-43982 |
Americus |
11/15/2019 |
11/15/2026 |
Active |
| Memory Care Endorsement |
MC-11937 |
Americus |
11/15/2019 |
11/15/2026 |
Active |
27. Healthcare Provider / CMS / NPI Summary
| Item |
Sample Result |
| NPI Profile |
No NPI profile identified in sample search. |
| CMS Certification Number |
Not identified in sample search. |
| Medicare Care Compare Profile |
Not identified in sample search. |
| State Healthcare License |
Active sample home care, assisted living, and memory care licensing-style records shown. |
| Provider Type Indicated |
Private home care / assisted living / memory care. |
28. Public Record and Online Information Summary
| Area Reviewed |
Sample Findings |
| Secretary of State |
Entity shown as active/compliant in this sample. |
| Website |
Website descriptions align with reported senior care and home care operations. |
| Google Maps |
Locations appear consistent with reported office, satellite, and residential care uses. |
| OSHA Public Search |
No OSHA inspection activity identified in this sample search. |
| Bankruptcy Search |
No active bankruptcy record identified in this sample search. |
| Public Litigation Search |
Two minor closed collection matters noted in sample public records. No active employment or federal litigation identified in this sample search. |
| UCC Filings |
One UCC filing noted for vehicle/equipment financing. |
| DOT/FMCSA |
No USDOT number identified in sample search. |
29. Online Review Summary
| Source |
Rating |
Review Count |
Common Positive Themes |
| Google Reviews |
4.4 / 5.0 |
86 |
Friendly caregivers, communication, family support. |
| Facebook |
4.6 / 5.0 |
41 |
Positive family feedback and caregiver praise. |
| Indeed |
3.5 / 5.0 |
22 |
Flexible scheduling and meaningful caregiving work. |
| BBB |
A- |
3 complaints |
Business profile active; sample complaints noted as resolved. |
| Caring.com |
4.2 / 5.0 |
18 |
Care quality, caregiver reliability, family communication. |
30. AI-Assisted Public Information Summary
| Research Area |
AI-Assisted Summary |
| Operations |
Public-facing information supports senior care, home care, assisted living, memory care, care coordination, and limited transportation assistance. |
| Website Review |
Website services align with applicant-provided operations. |
| Job Posting Review |
Job titles and duties support caregiver, memory care, care coordination, supervision, and transportation functions. |
| Location Review |
Locations align with office, satellite, and residential care uses. |
| Licensing Review |
Sample licensing information supports home care, assisted living, and memory care operations. |
| Public Record Review |
No active bankruptcy, OSHA inspection activity, or DOT profile identified in sample searches. |
31. Carrier-Facing Summary Narrative
Southern Grace Home Care & Senior Services, LLC is an established Georgia senior care provider with a reported business start date of 07/15/2016. The company operates from three Georgia locations in Albany, Leesburg, and Americus and reports operations focused on non-medical home care, companion care, personal care assistance, respite care, medication reminders, transportation assistance, assisted living, and memory care services.
Public corporate filing information in this sample reflects an active/compliant Georgia entity. The company’s website, online profiles, job posting information, licensing-style information, and location research appear consistent with the operations reported in the ACORD 130-style application information.
The applicant reports $2,000,000 in annual payroll allocated across home care field caregivers, assisted living/memory care staff, clerical office employees, outside sales/care coordinators, and transportation aides. The largest payroll category is home care field caregiver operations, representing 62.5% of total reported payroll. The largest employee category is also home care field caregivers, representing 53.7% of total reported employees.
Prior insurance history provided in this sample shows an expiring premium of $79,600 and a reported current experience mod of 0.98. The applicant also reports safety and business practices including new hire training, annual caregiver training, patient transfer training, MVR checks, a drug-free workplace program, return-to-work procedures, accident investigation, safety meetings, and client home safety checklists.
Based on the information provided and the sample public information reviewed, the account presents a clear, organized, and well-documented workers’ compensation submission with identified locations, officers, operations, payroll classifications, employee counts, safety practices, vehicle information, licensing information, public profile context, and prior insurance history.
32. Quick Summary
| Metric |
Sample Value |
| Applicant |
Southern Grace Home Care & Senior Services, LLC |
| DBA |
Southern Grace Home Care |
| State |
Georgia |
| Locations |
3 |
| Reported Full-Time Employees |
81 |
| Reported Part-Time Employees |
66 |
| Total Reported Employees |
147 |
| Reported Annual Payroll |
$2,000,000 |
| Largest Payroll Category |
Home health care / in-home caregivers — 62.5% |
| Largest Employee Category |
Home care field caregivers — 53.7% |
| Reported Current Experience Mod |
0.98 |
| Expiring Premium |
$79,600 |
| Business Profile |
Established Georgia senior care, home care, assisted living, and memory care provider. |
33. References and Source Notes
The following links represent sample reference sources that may be used to gather or verify information for the report.
Some company-specific links are sample search/profile links because the company in this sample report is fictional.
| Reference Category |
Source / Link |
Date Reviewed |
Information Used |
Match Confidence |
| Company Website |
Company Website |
03/15/2026 |
Services, operations, locations, public business description. |
High |
| Georgia Secretary of State |
Georgia Business Search |
03/15/2026 |
Entity status, formation date, registered agent, principal office. |
High |
| Georgia Department of Community Health |
Georgia DCH |
03/15/2026 |
Healthcare licensing-style information. |
Medium |
| Healthcare Facility Regulation |
Healthcare Facility Regulation Division |
03/15/2026 |
Facility/license context. |
Medium |
| Google Business Search |
Google Search |
03/15/2026 |
Business profile, online presence, reviews, public descriptions. |
Medium |
| Albany Location Map |
Google Maps: Albany |
03/15/2026 |
Location verification and area context. |
Medium |
| Leesburg Location Map |
Google Maps: Leesburg |
03/15/2026 |
Location verification and area context. |
Medium |
| Americus Location Map |
Google Maps: Americus |
03/15/2026 |
Location verification and area context. |
Medium |
| Facebook |
Facebook Search |
03/15/2026 |
Social profile, public posts, community presence. |
Medium |
| LinkedIn |
LinkedIn Company Search |
03/15/2026 |
Company profile, employee count, hiring activity. |
Medium |
| Indeed |
Indeed Job Search |
03/15/2026 |
Job postings, duties, wage ranges, staffing activity. |
Medium |
| BBB |
BBB Search |
03/15/2026 |
Business profile and reputation information. |
Medium |
| Caring.com |
Caring.com Search |
03/15/2026 |
Senior care profile and review information. |
Medium |
| OSHA Establishment Search |
OSHA Establishment Search |
03/15/2026 |
Inspection record search. |
Medium |
| OSHA Severe Injury Reports |
OSHA Severe Injury Reports |
03/15/2026 |
Severe injury report search. |
Medium |
| FMCSA SAFER |
FMCSA SAFER Company Snapshot |
03/15/2026 |
USDOT / motor carrier profile search. |
Medium |
| FMCSA SMS |
FMCSA SMS |
03/15/2026 |
Inspection, crash, and safety profile search. |
Medium |
| Georgia DOT Crash Reporting |
Georgia DOT Crash Reporting |
03/15/2026 |
General roadway/crash data reference. |
General Reference |
| Georgia Governor’s Office of Highway Safety |
Georgia Highway Safety |
03/15/2026 |
General roadway safety context. |
General Reference |
| U.S. Census QuickFacts |
U.S. Census QuickFacts |
03/15/2026 |
Population and community context. |
General Reference |
| NAICS Search |
NAICS Search |
03/15/2026 |
Industry code reference. |
General Reference |
| SIC Search |
SIC Search |
03/15/2026 |
Industry code reference. |
General Reference |
End of sample workers’ compensation submission summary.