| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGCY LLC | AGENCY PO BOX 85638 SAN DIEGO, CA 92186 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 2.64% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF AN MMA COMPANY | 101 N CHERRY ST WINSTON SALEM, NC 27101 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 1.56% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $80 | $80 | 0.11% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGRIFF, A MARSH & MCLENNAN AG | 7701 AIRPORT CENTER DRIVE STE 1800 GREENSBORO, NC 27409 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $127 | $3K | 12.10% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $767 | $0 | $767 | 3.48% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGRIFF, A MARSH & MCLENNAN AG | 7701 AIRPORT CENTER DRIVE SUITE 1800 GREENSBORO, NC 27409 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $93 | $2K | 11.92% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $598 | $0 | $598 | 3.64% |
| VAN EPPS, JAMES, H3 Filed as: VAN EPPS, JAMES H | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $943 | $47 | $990 | 6.25% |
| BLOCK, CHARLES, D3 Filed as: BLOCK, CHARLES D | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $943 | $47 | $990 | 6.25% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGRIFF, A MARSH & MCLENNAN AGENCY | 7701 AIRPORT CENTER DRIVE SUITE 1800 GREENSBORO, NC 27409 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $808 | $73 | $881 | 5.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 ADMIN | Claims processing Service code 12 | — | $13K |
| CAPITAL ADVANTAGE ASSURANCE COMPANY EIN 45-5492167 ADMIN | Claims processing Service code 12 | — | -$186K |
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 | 358 | 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) | 358 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 358 | $86K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 44 | $22K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 358 | $70K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 58 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 358 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.