| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KENNETH S. HARBIN3 | 1801 SKYWAY DRIVE MONROE, NC 28110 | BLUECROSS BLUESHIELD OF NORTH CAROLINA | $50K | $0 | $50K | 3.05% |
| ERIC W. BLACK3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | BLUECROSS BLUESHIELD OF NORTH CAROLINA | $6K | $0 | $6K | 0.34% |
| CONTEMPORARY BENEFITS ADVISORS LLC3 | 1801 SKYWAY DRIVE MONROE, NC 28110 | HUMANA INSURANCE COMPANY | $5K | $4K | $9K | 5.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4250 CONGRESS STREET, SUITE 200 CHARLOTTE, NC 28209 | HUMANA INSURANCE COMPANY | $1K | $0 | $1K | 0.84% |
| CONTEMPORARY BENEFITS ADVISORS LLC3 | 1956 WELLNESS BOULEVARD MONROE, NC 28110 | USABLE LIFE | $13K | $176 | $13K | 12.24% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $10K | $0 | $10K | 8.83% |
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 | 146 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF NORTH CAROLINA | 298 | $1.6M |
| Dental | HUMANA INSURANCE COMPANY | 138 | $162K |
| Vision | HUMANA INSURANCE COMPANY | 138 | $162K |
| Life insurance | USABLE LIFE | 146 | $110K |
| Short-term disability | USABLE LIFE | 146 | $110K |
| Long-term disability | USABLE LIFE | 146 | $110K |
| Prescription drug | BLUECROSS BLUESHIELD OF NORTH CAROLINA | 298 | $1.6M |
| Other | USABLE LIFE | 146 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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.