| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN M. HILTON3 | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $45K | — | $45K | 2.18% |
| BENEFIT CONTROLS OF THE CAROLINAS3 | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $398 | $5K | 4.81% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62689 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $27 | $4K | 3.78% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 2045 14TH AVENUE VERO BEACH, FL 32960 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $27 | $3K | 3.19% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 61007 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | — | $1K | $1K | 1.17% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | — | $7K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62689 VIRGINIA BEACH, VA 23466 | EYEMED | $1K | — | $1K | 8.92% |
| IBSI HOLDINGS INC3 Filed as: IBSI BROKERS | PO BOX 24337 WINSTON SALEM, NC 27114 | EYEMED | $736 | — | $736 | 4.46% |
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 | 149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 312 | $2.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 476 | $103K |
| Vision | EYEMED | 311 | $16K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 149 | $72K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 149 | $72K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 312 | $2.1M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 149 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 476 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.