| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA GROUP INSURANCE | $14K | — | $14K | 0.71% |
| WISTED, DANIEL, J3 Filed as: WISTED, DANIEL J. | 3440 PRESTON RIDGE RD STE 325 ALPHARETTA, GA 30005 | PROVIDENT LIFE & ACCIDENT INSURANCE COMPANY | $12K | — | $12K | 50.45% |
| WISTED, DANIEL, J3 Filed as: WISTED, DANIEL J | PRESTON RDG IV STE 325 3440 PRESTON RIDGE RD ALPHARETTA, GA 30005 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 34.04% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCK BOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA GROUP INSURANCE | $55 | — | $55 | 0.86% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA GROUP INSURANCE | — | $25 | $25 | 0.89% |
| DANIEL J WISTED3 Filed as: DANIEL J. WISTED | PRESTON RIDGE IV STE 325 3440 PRESTON RIDGE RD ALPHARETTA, GA 30005 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY, TENNESSEE | $368 | — | $368 | 35.52% |
| DONALD QUINT3 | 1924 S UTICA STE 710 TULSA, OK 74104 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY, TENNESSEE | $2 | — | $2 | 0.19% |
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 | 5,321 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 5,321 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Short-term disability(2 contracts) | CIGNA GROUP INSURANCE | 105 | $9K |
| Long-term disability(4 contracts, 3 carriers) | CIGNA GROUP INSURANCE | 5,321 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,321 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.