| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DANIEL J WISTED3 | 3440 PRESTON RIDGE RD, SUITE 325 ALPHARETTA, GA 30005 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $93K | $53K | $145K | 20.76% |
| RICHARD ANTHONY DEVITA3 | 5813 CAMILLA DRIVE CHARLOTTE, NC 28226 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9K | — | $9K | 1.25% |
| MICHAEL H GODWIN3 | 6 CONCOURSE PARKWAY, SUITE 2750 ATLANTA, GA 30328 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.19% |
| J S BENEFITS INC3 | 2200 LAKESHORE DR, SUITE 215 BIRMINGHAM, AL 35209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $533 | $656 | $1K | 0.17% |
| THOMAS S. JOHNSON3 Filed as: THOMAS STERLING JOHNSON | 2200 LAKESHORE DR, SUITE 215 BIRMINGHAM, AL 35209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $513 | — | $513 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDCOST BENEFIT SERVICES EIN 56-2056821 NONE | Contract Administrator Service code 13 | — | $516K |
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 | 492 | 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) | 492 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DENTAL DENTAL OF MISSOURI | 2,409 | $736K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,165 | $869K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 269 | $388K |
| Long-term disability(2 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,175 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,409 | — |
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.