| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VCG CONSULTANTS LLC3 | 999 PEACHTREE ST NE, STE 1500 ATLANTA, GA 30309 | METROPOLITAN LIFE INSURANCE COMPANY | $130K | — | $130K | 4.05% |
| VCG CONSULTANTS LLC3 | 999 PEACHTREE STREET NE STE 1500 ATLANTA, GA 30309 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $836 | $836 | 0.08% |
| VISUAL BENEFIT COMMUNICATIONS INC3 | 7500 MEMORIAL PKWY SW STE 211 HUNTSVILLE, AL 35802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | — | $7K | 1.22% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 0.73% |
| VCG CONSULTANTS LLC3 | 999 PEACHTREE STREET NE SUITE 1500 ATLANTA, GA 30309 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 0.51% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS SERVICES INC | 246 INVERNESS CENTER DRIVE BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 0.43% |
| TEARLE BAGWELL3 Filed as: TEARLE D BAGWELL | 7800 S MEMORIAL PKWY STE 211 HUNTSVILLE, AL 35802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.24% |
| JOHN WEBSTER3 Filed as: JOHN B WEBSTER | PO BOX 36190 BIRMINGHAM, AL 35236 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $680 | — | $680 | 0.12% |
| CUNDY, INC.3 Filed as: CUNDY INSURANCE AGENCY INC | PO BOX 24080 FORT LAUDERDALE, FL 33307 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $347 | — | $347 | 0.06% |
| PAUL SAIA AND MISC. AGENTS3 Filed as: PAUL L SAIA | 201 OFFICE PARK DR STE 300 BIRMINGHAM, AL 35223 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $234 | — | $234 | 0.04% |
| MJ INSURANCE3 Filed as: DONNA D BAGWELL | PO BOX 13028 HUNTSVILLE, AL 35802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $204 | — | $204 | 0.04% |
| THOMAS C CUNDY3 | PO BOX 24080 FORT LAUDERDALE, FL 33307 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $189 | — | $189 | 0.03% |
| LOUIS R FAIOLA3 Filed as: LOUIS J PANTALONE | CUSTOM BENEFITS PROGRAMS INC PO BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $136 | — | $136 | 0.02% |
| MASTER UNUM ENROLL3 Filed as: UNUM ENROLL SOUTHEAST MIDWEST | 1 FOUNTAIN SQUARE CHATTANOOGA, TN 37402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 0.01% |
| PANTALONE, JO, ANN3 Filed as: JO A PANTALONE | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $78 | — | $78 | 0.01% |
| DARELL LAWAYNE EIDSON3 Filed as: DARELL L EIDSON | 246 INVERNESS CENTER DR BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.00% |
| SERE E ROLLINS3 | 999 PEACHTREE ST NE STE 1500 ATLANTA, GA 30309 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.00% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.00% |
| KEN WILLARD ASSOCIATES INC3 | 3071 VISTAPOINT ROAD MIDLOTHIAN, VA 23113 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.00% |
| RICHARD FULLER HERRING3 Filed as: RICHARD F HERRING SR | 246 INVERNESS CENTER DR BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.00% |
| SANDRA D OZMENT3 | 1608 OAK ST GREENSBORO, NC 27403 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| VCG CONSULTANTS LLC3 | 999 PEACHTREE STREET NE ST 1500 ATLANTA, GA 30309 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $47K | — | $47K | 13.52% |
| HERRING, RICHARD, FULLER3 | 246 INVERNESS CENTER DRIVE BIRMINGHAM, AL 35242 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $19K | $0 | $19K | 6.72% |
| SCHNEIDER, LESLIE A3 | 999 PEACHTREE STREET NE SUITE 1500 ATLANTA, GA 30309 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $4 | $10K | 3.62% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS SERVICES INC | 246 INVERNESS CENTER DRIVE BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $62 | $3K | 1.30% |
| VCG CONSULTANTS LLC3 | 999 PEACHTREE STREET NE STE 1500 ATLANTA, GA 30309 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 0.69% |
| HERRING, RICHARD, FULLER3 | 246 INVERNESS CENTER DRIVE BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.56% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $965 | — | $965 | 0.41% |
| SCHNEIDER, LESLIE A3 | 999 PEACHTREE STREET NE SUITE 1500 ATLANTA, GA 30309 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $890 | — | $890 | 0.38% |
| EIDSON, DARELL, LAWAYNE3 Filed as: EIDSON, DARRELL, LAWAYNE | 246 INVERNESS CENTER DERIVE BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $605 | $15 | $620 | 0.26% |
| CUNDY, INC.3 Filed as: CUNDY INSURANCE AGENCY INC | PO BOX 24080 FORT LAUDERDALE, FL 33307 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $614 | — | $614 | 0.26% |
| CUNDY, INC.3 Filed as: CUNDY, THOMAS, CARROLL | PO BOX 24080 FORT LAUDERDALE, FL 33307 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $360 | — | $360 | 0.15% |
| PANTALONE, JO, ANN3 Filed as: PANTALONE, LOUIS, J | CUSTOM BENEFIT PROGRAMS INC PO BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $101 | — | $101 | 0.04% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 701 MARKET STREET ST. LOUIS, MO 63101 | NATIONAL UNION FIRE INS.C CO. OF PITTSBURGH, PA | $4K | — | $4K | 25.00% |
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 | 2,815 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 969 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,784 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HMSA | 0 | $1K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 6,801 | $3.2M |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 4,141 | $348K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 6,801 | $3.4M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,579 | $991K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,579 | $991K |
| Other(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 6,801 | $4.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,801 | — |
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.