| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAIGE A HARRIS3 | 101 LEE PLACE WASHINGTON, NC 27889 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $11K | — | $11K | 0.66% |
| ANDREW WILLIAMS3 | 550 OLD THOMASVILLE ROAD WINSTON SALEM, NC 27107 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $2K | — | $2K | 0.13% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON CHAPMAN BENEFIT ADMIN | BLDG I SUITE 100 AUSTIN, TX 78729 | AMERICAN UNITED LIFE INSURANCE COMPANY | $39K | — | $39K | 25.00% |
| MARC JESSUP3 Filed as: MARC JESSUP INSURANCE | P.O.BOX 12890 NEW BERN, NC 285612890 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | — | $8K | 8.08% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 604502215 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 4.53% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | P.O. BOX 9201 AUSTIN, TX 787669201 | METROPOLITAN LIFE INSURANCE COMPANY | — | $3K | $3K | 2.99% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 604502215 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 1.81% |
| ORGERLY BENEFITS INC3 | 8 THE GRN STE A DOVER, DE 199013618 | METROPOLITAN LIFE INSURANCE COMPANY | $962 | — | $962 | 0.98% |
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 | 210 | 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) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 203 | $1.6M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $99K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 271 | $99K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 215 | $156K |
| Short-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 215 | $156K |
| Long-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 215 | $156K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 203 | $1.6M |
| Other(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 215 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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.