| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN K. GREENE3 | 8540 COLONNADE CENTER DRIVE RALEIGH, NC 27615 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $42K | — | $42K | 3.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203510 DALLAS, TX 75320 | STANDARD INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| IBSI HOLDINGS INC3 Filed as: IBSI HOLDINGS, INC. | 1381 OLD MILL CIRCLE, SUITE 301 WINSTON SALEM, NC 27103 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 6100 FAIRVIEW ROAD, SUITE 1000 CHARLOTTE, NC 28210 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.00% |
| IBSI HOLDINGS INC3 Filed as: IBSI HOLDINGS, INC. | PO BOX 24337 WINSTON SALEM, NC 27114 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $274 | $2K | 5.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 601478 CHARLOTTE, NC 28260 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $69 | $69 | 0.16% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $45 | $45 | 0.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203508 DALLAS, TX 75320 | COMMUNITY EYE CARE | $2K | — | $2K | 10.00% |
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 | 155 | 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) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 298 | $1.2M |
| Dental | STANDARD INSURANCE COMPANY | 137 | $80K |
| Vision | COMMUNITY EYE CARE | 309 | $16K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 155 | $42K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 155 | $42K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 155 | $42K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 298 | $1.2M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 155 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 309 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.