| 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 | $54K | — | $54K | 3.67% |
| 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. | $29K | — | $29K | 2.92% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 31817 CHARLOTTE, NC 28231 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $44K | — | $44K | 5.59% |
| 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 | — | $12K | $12K | 1.52% |
| 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 | — | $6K | $6K | 1.53% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PL CHICAGO, IL 60673 | VISION SERVICE PLAN | $27K | — | $27K | 10.52% |
| GREG I HINRICHS3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | $13K | $17K | 21.80% |
| 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 | $4K | $8K | 10.88% |
| DANIEL WARD RICHARDSON3 | 11525 N COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | — | $4K | 4.77% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | — | $4K | 4.57% |
| AFFINITY LTC, LLC3 Filed as: AFFINITY LTC, LLC C/O LTC GLOBAL | 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $1K | — | $1K | 2.48% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 29754 NETWORK PL SUITE 2500 CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $959 | — | $959 | 2.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PL CHICAGO, IL 60673 | METLIFE LEGAL PLANS | $4K | — | $4K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 13784 NEWARK, NJ 07188 | METLIFE LEGAL PLANS | — | $452 | $452 | 1.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 3000 BAYPORT DRIVE SUITE 300 TAMPA, FL 33607 | METLIFE LEGAL PLANS | — | $329 | $329 | 0.74% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 265 BROOKVIEW CENTRE WAY SUITE 505 KNOXVILLE, TN 37919 | METLIFE LEGAL PLANS | — | $96 | $96 | 0.21% |
| 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% |
| 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 | 22.57% |
| 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 | $4K | $5K | 17.91% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $1K | $3K | 8.55% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 4.40% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 4.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 29754 NETWORK PLACE CHICAGO, IL 60673 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $5K | — | $5K | 24.97% |
| MICHAEL S VANGAVREE3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $624 | — | $624 | 3.61% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $368 | — | $368 | 2.13% |
| ALTC FUNDING LLC3 | 16932 WOODINVILLE-REDMOND RD STE A-204 WOODINVILLE, WA 98072 | TRUSTMARK INSURANCE COMPANY | $4K | — | $4K | 22.72% |
| AFFINITY LTC, LLC3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $748 | — | $748 | 8.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $166 | — | $166 | 1.87% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $70 | $550 | $620 | 10.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $36 | $47 | $83 | 1.37% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $73 | — | $73 | 1.21% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $70 | — | $70 | 1.16% |
| GREG I HINRICHS3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $56 | $696 | $752 | 15.55% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $29 | $60 | $89 | 1.84% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $58 | — | $58 | 1.20% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $56 | — | $56 | 1.16% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $58 | $447 | $505 | 12.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $28 | $37 | $65 | 1.57% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $60 | — | $60 | 1.45% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $58 | — | $58 | 1.40% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $44 | $894 | $938 | 24.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $23 | $77 | $100 | 2.59% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $46 | — | $46 | 1.19% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $44 | — | $44 | 1.14% |
| MICHAEL S VANGAVREE3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $309 | — | $309 | 8.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $69 | — | $69 | 2.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMINISTRATOR | Non-monetary compensation; Claims processing; Named fiduciary; Participant communication; Other services; Direct payment from the plan; Contract Administrator; Float revenue Service code 12 | — | $1.8M |
| WILLIS TOWERS WATSON SOUTHEAST/NEWA BROKER | Insurance agents and brokers Service code 22 | 1120 SOUTH TYRON STREET SUITE 650 CHARLOTTE, NC 28203 | $114K |
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 | 1,772 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 94 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,866 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,976 | $1.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,746 | $1.5M |
| Vision | VISION SERVICE PLAN | 1,375 | $255K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,909 | $783K |
| Long-term disability(2 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,770 | $494K |
| Other(14 contracts, 7 carriers) | GENWORTH LIFE INSURANCE COMPANY | 155 | $287K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,746 | — |
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.