| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACS BENEFIT SERVICES LLC3 Filed as: ACS BENEFIT SERVICES INC | 8025 NORTH POINT BLVD WINSTON SALEM, NC 27106 | HARTFORD LIFE AND ACCIDENT | $47K | — | $47K | 7.26% |
| WELLS FARGO INSURANCE SERVICES7 Filed as: WELLS FARGO INSURANCE SERVICES USA | 6100 FAIRVIEW ROAD, SUITE 1400 CHARLOTTE, NC 28210 | JOHN HANCOCK LIFE INSURANCE COMPANY | $14K | — | $14K | 13.77% |
| GOODRUM, PHILLIP, PORTER5 | 4400 PARK ROAD, STE 307 CHARLOTTE, NC 28209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $17K | — | $17K | — |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL, IN | 6100 FAIRVIEW RD. STE 1400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $12K | — | $12K | — |
| IBENEFIT COMMUNICATION LLC5 Filed as: IBENEFIT COMMUNICATION | 4400 PARK ROAD STE 307 CHARLOTTE, NC 28209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | — |
| GOODRUM, PHILLIP, PORTER | 4400 PARK RD, STE 307 CHARLOTTE, NC 28209 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $25K | — | $25K | — |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL, IN | 6100 FAIRVIEW RD, STE 1400 CHARLOTTE, NC 28210 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $18K | — | $18K | — |
| IBENEFIT COMMUNICATION LLC Filed as: IBENEFIT COMMUNICATION | 4400 PARK RD, STE 307 CHARLOTTE, NC 28209 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CARE TEAM HEALTH, LLC EIN 81-3561997 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $285K |
| ACS BENEFIT SERVICES INC. EIN 26-0529453 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $224K |
| CIGNA EIN 59-1031071 CONTRACT ADMINISTRATOR | Other fees Service code 99 | — | $121K |
| OCCUPATIONAL HEALTH CENTERS OF OHIO EIN 26-3239286 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $27K |
| MEDWORK LLC EIN 20-8250937 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $26K |
| STRATOSE/ZELIS NETWORK EIN 26-1790538 PPO MANAGER | Claims processing Service code 12 | — | $6K |
| FLORES AND ASSOCIATES EIN 56-1542307 PPO MANAGER | Contract Administrator Service code 13 | — | $5K |
| COMPUNET CLINICAL LABORATORIES EIN 31-1258010 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $4K |
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 | 780 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 789 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 777 | $649K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 777 | $649K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 702 | $497K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 777 | $753K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 777 | — |
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.