| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROVIDENCE INSURANCE GROUP INC3 Filed as: THE PROVIDENCE INSURANCE GROUP INC | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 30062 | ANTHEM - ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE INC. | $222K | — | $222K | 5.17% |
| KARLE E STINEHOUR3 | 1862 ALLGOOD ROAD MARIETTA, GA 30062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $53K | — | $53K | 5.29% |
| PROVIDENCE INSURANCE GROUP INC3 Filed as: THE PROVIDENCE INSURANCE GROUP | 4180 PROVIDENCE RD STE 200 MARRIETTA, GA 30062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $18K | $18K | 1.83% |
| PROVIDENCE INSURANCE GROUP INC3 | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 30062 | PAN-AMERICAN LIFE INSURANCE COMPANY | $38K | — | $38K | 9.62% |
| PROVIDENCE INSURANCE GROUP INC3 | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 300626127 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $2K | $10K | 8.58% |
| PLANSOURCE BENEFIT ADMINISTRATION5 | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $819 | $3K | 2.51% |
| PROVIDENCE INSURANCE GROUP INC3 | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 300626127 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $811 | $8K | 10.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PAN-AMERICAN LIFE INS CO EIN 72-0281240 HLTH ADMIN | Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Trustee (bank, trust company, or similar financial institution) Service code 12 | — | $103K |
| NEXT GENERATION ENROLLMENT INC EIN 20-1650604 FSA TPA | Claims processing Service code 12 | — | $7K |
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 | 1,091 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,091 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM - ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE INC. | 838 | $4.7M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,091 | $995K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,091 | $995K |
| Life insurance(3 contracts, 2 carriers) | PAN-AMERICAN LIFE INSURANCE COMPANY | 781 | $581K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 781 | $190K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 781 | $190K |
| Stop-loss / reinsurancereinsurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 288 | $391K |
| Other(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,091 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,091 | — |
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.