| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DANIEL J WISTED3 | 3440 PRESTON RIDGE RD, STE 325 ALPHARETTA, GA 30005 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $113K | $53K | $165K | 18.00% |
| RICHARD ANTHONY DEVITA3 | 5813 CAMILLA DRIVE CHARLOTTE, NC 28226 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $29K | $0 | $29K | 3.21% |
| MICHAEL H GODWIN3 | 6 CONCOURSE PARKWAY, STE 2750 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 0.31% |
| J S BENEFITS INC3 | 2200 LAKESHORE DR, STE 215 BIRMINGHAM, AL 35209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $813 | $1K | $2K | 0.21% |
| THOMAS S. JOHNSON3 Filed as: THOMAS STERLING JOHNSON | 2200 LAKESHORE DR, STE 215 BIRMINGHAM, AL 35209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $745 | $0 | $745 | 0.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDCOST BENEFIT SERVICES EIN 56-2056821 NONE | Contract Administrator Service code 13 | — | $511K |
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 | 1,356 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 65 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,421 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MISSOURI | 3,077 | $823K |
| Vision | EYEMED VISION CARE | 2,686 | $120K |
| Life insurance | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 2,584 | $1.1M |
| Short-term disability | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 824 | $304K |
| Long-term disability(2 contracts, 2 carriers) | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 2,583 | $2.5M |
| Other | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 1,690 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,077 | — |
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."
No prospect flags tripped on this filing.