| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT SOLUTIONS3 | 580 DAVIDSON GATEWAY DRIVE DAVIDSON, NC 28036 | SECURITY LIFE INSURANCE CIMPANY | $8K | $0 | $8K | 10.00% |
| IBSI HOLDINGS INC3 | 3330 HEALY DRIVE, SUITE 100 WINSTON SALEM, NC 27103 | SECURITY LIFE INSURANCE CIMPANY | $4K | $0 | $4K | 5.00% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES SE INC | 1901 ROXBOROUGH ROAD CHARLOTTE, NC 28211 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $0 | $6K | 10.17% |
| PETER MICHAEL FOLEY JR3 | 150 PAMPLICO LANE MOORESVILLE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $877 | $4K | 7.19% |
| CAROLINA BENEFITS SOURCE INC3 | 4461 NE 30TH AVE LIGHTHOUSE PT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $102 | $3K | 5.85% |
| ROLANDO HIRAM DORTA3 | 3011 PISGAH PLACE GREENSBORO, NC 27455 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $758 | $26 | $784 | 1.34% |
| DAVID MASON DOKELL3 | 127 GREAT POINT DR MOORESVILLE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $646 | $132 | $778 | 1.33% |
| AFFINITI INC3 | 6813 LINDA LAKE DR CHARLOTTE, NC 28215 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $656 | $0 | $656 | 1.12% |
| MARK BRANNON SWARD3 | 8230 CARTER CREEK DR CHARLOTTE, NC 28227 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $415 | $1 | $416 | 0.71% |
| RAMEY FESPERMAN3 | 7319 MATTHEWS MINT HILL RD MATTHEWS, NC 28227 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $127 | $105 | $232 | 0.40% |
| WILLIAM T MILLER3 | 2908 OTRANTO ROAD NORTH CHARLESTON, SC 29406 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | $0 | $95 | 0.16% |
| TIM JARRELL3 | 301 S ELM ST GREENSBORO, NC 27401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | $14 | $78 | 0.13% |
| DOUGLAS R. KILLIAN3 Filed as: DOUGLAS RICHARD KILLIAN | P O BOX 443 STOKESDALE, NC 27357 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | $0 | $42 | 0.07% |
| ELITE ADMINISTRATION3 | 193 SCHLAFER RD BAINBRIDGE, NY 13733 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $9 | $24 | 0.04% |
| GROUP BENEFIT SOLUTIONS3 Filed as: GROUP BENEFIT SOLUTIONS INC | 280 DAVIDSON GATEWAY DR DAVIDSON, NC 28036 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | $0 | $6K | 15.49% |
| CAROLINA BENEFITS SOURCE INC3 | 4461 NE 30TH AVE LIGHTHOUSE PT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $10 | $3K | 49.18% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES SE INC | 1901 ROXBOROUGH RD CHARLOTTE, NC 28211 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $639 | $0 | $639 | 9.93% |
| PETER MICHAEL FOLEY JR3 | 150 PAMPLICO LANE MOORESVILLE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $427 | $106 | $533 | 8.28% |
| DAVID MASON DOKELL3 | 127 GREAT POINT DR MOORESVILLE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $78 | $16 | $94 | 1.46% |
| AFFINITI INC3 | 6813 LINDA LAKE DR CHARLOTTE, NC 28215 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $93 | $0 | $93 | 1.45% |
| MARK BRANNON SWARD3 | 8230 CARTER CREEK DR CHARLOTTE, NC 28227 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | $0 | $48 | 0.75% |
| WILLIAM T MILLER3 | 2908 OTRANTO ROAD NORTH CHARLESTON, SC 29406 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.19% |
| RAMEY FESPERMAN3 | 7319 MATTHEWS MINT HILL RD MATTHEWS, NC 28227 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $2 | $7 | 0.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE, INC EIN 35-1846036 NONE | Plan Administrator; Claims processing; Other services Service code 12 | 5200 SEVENTY-SEVEN CENTER DR. 400 CHARLOTTE, NC 28217 | $67K |
| GROUP BENEFIT SOLUTIONS EIN 27-1018705 NONE | Consulting (general); Insurance agents and brokers Service code 16 | 580 DAVIDSON GATEWAY DRIVE DAVIDSON, NC 28036 | $54K |
| CIGNA PPO EIN 59-1031071 NONE | Claims processing; Other services Service code 12 | 11016 RUSHMORE DRIVE, STE 300 CHARLOTTE, NC 28277 | $29K |
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 | 183 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 69 | $65K |
| Dental | SECURITY LIFE INSURANCE CIMPANY | 183 | $80K |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 180 | $105K |
| Short-term disability(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 180 | $105K |
| Long-term disability(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 180 | $105K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 175 | $279K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 183 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.