| 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. | $221K | — | $221K | 4.52% |
| PROVIDENCE INSURANCE GROUP INC3 | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 300626127 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $27K | $5K | $31K | 9.72% |
| PLANSOURCE BENEFIT ADMINISTRATION5 Filed as: PLANSOURCE BENEFIT ADMINISTRAT | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | -$2K | $6K | 1.78% |
| PROVIDENCE INSURANCE GROUP INC3 | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 30062 | PAN-AMERICAN LIFE INSURANCE COMPANY | $31K | — | $31K | 9.62% |
| KARLE E STINEHOUR3 | 1862 ALLGOOD ROAD MARIETTA, GA 30062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $72K | — | $72K | 26.37% |
| 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 | — | $22K | $22K | 8.00% |
| PROVIDENCE INSURANCE GROUP INC3 | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 300626127 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $1K | $10K | 8.69% |
| PLANSOURCE BENEFIT ADMINISTRATION5 | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | -$819 | $2K | 1.36% |
| PROVIDENCE INSURANCE GROUP INC3 | 4180 PROVIDENCE RD STE 200 MARIETTA, GA 30062 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $20K | — | $20K | 28.55% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 2.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PAN-AMERICAN LIFE INS CO EIN 72-0281240 HLTH ADMIN | Other fees; Trustee (bank, trust company, or similar financial institution); Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | 601 POYDRAS NEW ORLEANS, LA 70130 | $36K |
| PROVIDENCE INSURANCE GROUP INC INSURANCE BROKER | Insurance agents and brokers Service code 22 | 4180 PROVIDENCE RD SUITE 200 MARIETTA, GA 30062 | $19K |
| PAN-AMERICAN BENEFIT SOLUTIONS CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 1778 NO PLANO RD #310 RICHARDSON, TX 75081 | $17K |
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 | 2,176 | 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) | 2,176 | 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. | 941 | $5.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 894 | $274K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 894 | $274K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,176 | $434K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,176 | $324K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,176 | $434K |
| Stop-loss / reinsurancereinsurance | PAN-AMERICAN LIFE INSURANCE COMPANY | 366 | $322K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,176 | $503K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,176 | — |
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.