| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEVEN F DUCKETT | 400 NORTH EXECUTIVE DRIVE SUITE 300 BROOKFIELD, WI 53005 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $20K | — | $20K | 8.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE INC STE 300 BROOKFIELD, WI 53005 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 6.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | PO BOX 101162 PASADENA, CA 91189 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $1K | $1K | 2.26% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS OF WISCONSIN, INC. | 93033 NETWORK PL CHICAGO, IL 60673 | VISION SERVICE PLAN | — | $7K | $7K | 24.39% |
| NEW ENGLAND EMPLOYEE BENEFITS CO3 Filed as: METLIFE FINANCIAL/METLIFE SECURITIE | 1095 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1K | $1K | — |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 93033 NETWORK PL CHICAGO, IL 60673 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $213 | $1K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FLORES AND ASSOCIATES EIN 56-1542307 | Contract Administrator Service code 13 | 1218 SOUTH CHURCH STREET CHARLOTTE, NC 28203 | $7K |
| ACS BENEFIT SERVICES INC EIN 56-1472467 | Claims processing; Contract Administrator Service code 12 | 8025 NORTH POINT BLVD SUITE 100 WINSTON-SALEM, NC 27106 | $7K |
| CIGNA EIN 59-1031071 | Contract Administrator Service code 13 | PO BOX 645014 CINCINNATI, OH 45264 | $3K |
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 | 170 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 166 | $246K |
| Vision | VISION SERVICE PLAN | 143 | $30K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 169 | $61K |
| Long-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 169 | $61K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 166 | $246K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 166 | $246K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 169 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 169 | — |
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.