| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 717 NORTH HARDWOOD, SUITE 2500 DALLAS, TX 75201 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $25K | $25K | 1.86% |
| LOCKTON COMPANIES, LLC3 | 8110 EAST UNION AVENUE, SUITE 700 DENVER, CO 80237 | BLUE CROSS BLUE SHIELD OF GEORGIA, INC. | — | $1K | $1K | 0.74% |
| HERRING, RICHARD, FULLER3 | 246 INVERNESS CENTER DRIVE BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $533 | — | $533 | 2.35% |
| EIDSON, DARELL, LAWAYNE3 | 246 INVERNESS CENTER DRIVE BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $445 | — | $445 | 1.97% |
| VERITAS CONSULTING GROUP LLC3 Filed as: VERITAS CONSULTING GROUP, LLC | 999 PEACHTREE STREET NE, SUITE 1500 ATLANTA, GA 30309 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $194 | — | $194 | 0.86% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS SERVICES, INC. | 246 IVERNESS CENTER DRIVE BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $169 | — | $169 | 0.75% |
No Schedule C service providers reported on this filing.
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 | 1,750 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 25 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 147 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,922 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL INSURANCE COMPANY | 4,423 | $1.2M |
| Vision | BLUE CROSS BLUE SHIELD OF GEORGIA, INC. | 3,546 | $148K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 2,073 | $1.4M |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 2,073 | $1.4M |
| Other(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 2,073 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,423 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.