| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $66K | — | $66K | 4.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | -$3 | — | -$3 | -0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, MD 20854 | KAISER FOUNDATION HEALTH PLAN, INC. | $34K | — | $34K | 3.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 31817 CHARLOTTE, NC 28231 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $63K | — | $63K | 6.55% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 233 S. WACKER DR STE 1800 CHICAGO, IL 60606 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $14K | $14K | 1.49% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 233 S. WACKER DR STE 1800 CHICAGO, IL 60606 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $8K | $8K | 1.49% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PL CHICAGO, IL 60673 | VISION SERVICE PLAN | $26K | — | $26K | 9.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTH | 29754 NETWORK PLACE CHICAGO, IL 60673 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $13K | — | $13K | 8.42% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTH | 29754 NETWORK PLACE CHICAGO, IL 60673 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | — | $9K | 8.07% |
| GREG I HINRICHS3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $3K | $5K | $8K | 8.59% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | $1K | $5K | 5.32% |
| DANIEL WARD RICHARDSON3 | 11525 N COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | — | $4K | 3.76% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $3K | — | $3K | 3.60% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PL CHICAGO, IL 60673 | METLIFE LEGAL PLANS | $5K | — | $5K | 9.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 13784 NEWARK, NJ 07188 | METLIFE LEGAL PLANS | — | $404 | $404 | 0.76% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 265 BROOKVIEW CENTRE WAY SUITE 505 KNOXVILLE, TN 37919 | METLIFE LEGAL PLANS | — | $141 | $141 | 0.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 301 SOUTH TRYON STREET CHARLOTTE, NC 28282 | METLIFE LEGAL PLANS | — | $63 | $63 | 0.12% |
| AFFINITY LTC, LLC3 Filed as: AFFINITY LTC, LLC C/O LTC GLOBAL | 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $4K | — | $4K | 8.65% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 29754 NETWORK PL SUITE 2500 CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $955 | — | $955 | 1.96% |
| AON CONSULTING INC3 Filed as: AON CONSULTING INC. | ONE LIBERTY PLAZA 165 BROADWAY STE 3201 NEW YORK, NY 10006 | ACE AMERICAN INSURANCE COMPANY | $8K | — | $8K | 20.00% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $2K | $3K | 8.76% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $548 | $2K | 5.65% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.97% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.80% |
| MICHAEL S VANGAVREE3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $1K | — | $1K | 7.71% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $318 | — | $318 | 1.72% |
| ALTC FUNDING LLC3 | 16932 WOODINVILLE-REDMOND RD STE A-204 WOODINVILLE, WA 98072 | TRUSTMARK INSURANCE COMPANY | $4K | — | $4K | 21.85% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $151 | $514 | $665 | 5.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $78 | $87 | $165 | 1.29% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $158 | — | $158 | 1.24% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $151 | — | $151 | 1.18% |
| AFFINITY LTC, LLC3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $800 | — | $800 | 9.63% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $178 | — | $178 | 2.14% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $90 | $202 | $292 | 3.72% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 1.20% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $90 | — | $90 | 1.15% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $47 | $35 | $82 | 1.04% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $87 | $178 | $265 | 4.28% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $90 | — | $90 | 1.45% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $87 | — | $87 | 1.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $42 | $27 | $69 | 1.11% |
| MICHAEL S VANGAVREE3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $309 | — | $309 | 9.89% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $69 | — | $69 | 2.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | JP MORGAN CHASE PO BOX 13784 NEWARK, NJ 07188 | DELAWARE AMERICAN LIFE INSURANCE OF AMERICA | $225 | — | $225 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMINISTRATOR | Named fiduciary; Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Float revenue; Participant communication Service code 12 | — | $2.0M |
| WILLIS TOWERS WATSON SOUTHEAST/NEWA BROKER | Insurance agents and brokers Service code 22 | 1120 SOUTH TYRON STREET SUITE 650 CHARLOTTE, NC 28203 | $127K |
| EVERNORTH CARE SOLUTIONS EIN 86-1465626 ADMINISTRATOR | Participant communication; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $35K |
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 | 2,125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 70 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,895 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 3,086 | $1.5M |
| Vision | VISION SERVICE PLAN | 1,562 | $280K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,116 | $957K |
| Long-term disability(2 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,117 | $607K |
| Other(16 contracts, 10 carriers) | GINGER.IO OF CALIFORNIA MEDICAL P.C. | 2,125 | $715K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,086 | — |
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.