| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $31K | — | $31K | 1.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $26K | — | $26K | 1.64% |
| 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. | $28K | — | $28K | 3.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 31817 CHARLOTTE, NC 28231 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $48K | — | $48K | 6.53% |
| 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 | — | $10K | $10K | 1.36% |
| 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 | — | $5K | $5K | 1.35% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | 29754 NETWORK PL CHICAGO, IL 60673 | VISION SERVICE PLAN | $28K | — | $28K | 9.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | 29754 NETWORK PL. CHICAGO, IL 60673 | VISION SERVICE PLAN | $15 | — | $15 | 0.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTH | 29754 NETWORK PLACE CHICAGO, IL 60673 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | $20K | — | $20K | 11.83% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTH | 29754 NETWORK PLACE CHICAGO, IL 60673 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | $19K | — | $19K | 11.83% |
| GREG I HINRICHS3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $3K | $6K | $9K | 11.92% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $3K | $2K | $5K | 6.33% |
| DANIEL WARD RICHARDSON3 | 11525 N COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $3K | — | $3K | 4.05% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $3K | — | $3K | 3.88% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PL CHICAGO, IL 60673 | METLIFE LEGAL PLANS | $5K | — | $5K | 10.14% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 29982 NETWORK PLACE CHICAGO, IL 60673 | METLIFE LEGAL PLANS | — | $593 | $593 | 1.25% |
| AFFINITY LTC, LLC3 | 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $4K | — | $4K | 9.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 29754 NETWORK PL SUITE 2500 CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $926 | — | $926 | 2.06% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $3K | $4K | 12.55% |
| 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 | $750 | $2K | 6.63% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 4.14% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.97% |
| MICHAEL S VANGAVREE3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $2K | — | $2K | 12.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $388 | — | $388 | 2.42% |
| ALTC FUNDING LLC3 | 16932 WOODINVILLE-REDMOND RD STE A-204 WOODINVILLE, WA 98072 | TRUSTMARK INSURANCE COMPANY | $3K | — | $3K | 22.93% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $306 | $1K | $1K | 9.01% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $320 | — | $320 | 2.19% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $306 | — | $306 | 2.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $65 | $183 | $248 | 1.70% |
| AFFINITY LTC, LLC3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $906 | — | $906 | 8.67% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $201 | — | $201 | 1.92% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $195 | $613 | $808 | 8.95% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $204 | — | $204 | 2.26% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $195 | — | $195 | 2.16% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON, INC. | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $39 | $116 | $155 | 1.72% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $115 | $321 | $436 | 7.34% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $120 | — | $120 | 2.02% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $115 | — | $115 | 1.94% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $62 | $86 | 1.45% |
| GREG I HINRICHS3 Filed as: GREG HINRICHS I | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $94 | $268 | $362 | 7.88% |
| DANIEL WARD RICHARDSON3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $98 | — | $98 | 2.13% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD. CHARLOTTE, NC 28277 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 2.05% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $46 | $70 | 1.52% |
| 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 | Participant communication; Contract Administrator; Float revenue; Other services; Claims processing; Direct payment from the plan; Named fiduciary; Non-monetary compensation Service code 12 | — | $1.5M |
| WILLIS TOWERS WATSON SOUTHEAST/CHIC BROKER | Insurance agents and brokers Service code 22 | 1120 SOUTH TYRON STREET SUITE 650 CHARLOTTE, NC 28203 | $64K |
| WILLIS TOWERS WATSON SOUTHEAST/NEWA BROKER | Insurance agents and brokers Service code 22 | 1120 SOUTH TYRON STREET SUITE 650 CHARLOTTE, NC 28203 | $63K |
| WILLIS TOWERS WATSON BROKER | Insurance agents and brokers Service code 22 | 1120 SOUTH TYRON STREET SUITE 650 CHARLOTTE, NC 28203 | $38K |
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 | 2,234 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 64 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,298 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 2,706 | $830K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 3,266 | $1.6M |
| Vision | VISION SERVICE PLAN | 1,624 | $282K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,272 | $735K |
| Long-term disability(2 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,279 | $472K |
| Other(17 contracts, 10 carriers) | GINGER.IO OF CALIFORNIA MEDICAL P.C. | 2,706 | $724K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,266 | — |
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.