| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | HARTFORD LIFE AND ACCIDENT | $1K | — | $1K | 10.18% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62819 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $561 | — | $561 | 4.37% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES LLC | 4611 UNIVERSITY DR DURHAM, NC 27702 | HARTFORD LIFE AND ACCIDENT | — | $424 | $424 | 3.31% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF NORTH CAROLINA | $266 | — | $266 | 2.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | $108 | — | $108 | 7.82% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE SUITE 400 VALHALLA, NY 10595 | METROPOLITAN LIFE INSURANCE COMPANY | $23 | — | $23 | 1.67% |
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 | 104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 274 | $118K |
| Dental | DELTA DENTAL OF NORTH CAROLINA | 290 | $9K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 165 | $1K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 125 | $13K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 125 | $13K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 125 | $13K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 274 | $118K |
| Other | HARTFORD LIFE AND ACCIDENT | 125 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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."
No prospect flags tripped on this filing.