| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREG HINIRICHS3 | SOUTHPARK TOWERS SUITE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8K | $10K | $17K | 17.80% |
| DANIEL WARD RICHARDSON3 | 6000 FAIRVIEW ROAD STE 410 CHARLOTTE, NC 28110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8K | $366 | $8K | 8.16% |
| JAMES W DEUINK3 | SOUTHPARK TOWERS 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8K | — | $8K | 7.79% |
| IVAN HINRICHS3 | 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $366 | $366 | 0.37% |
| AON CONSULTING INC3 Filed as: AON HEWITT | 3115 S WACKER DRIVE, STE 1550 CHICAGO, IL 60606 | MAGELLAN BEHAVIORAL HEALTH | — | $4K | $4K | 10.44% |
| GREG HINIRICHS3 | SOUTHPARK TOWERS SUITE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $1K | $2K | 18.16% |
| DANIEL WARD RICHARDSON3 Filed as: DANIEL RICHARDSON | 6000 FAIRVIEW RD,STE 410 CHARLOTTE, NC 28110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $52 | $1K | 8.18% |
| JAMES W DEUINK3 | SOUTHPARK TOWERS 6000 FAIRVIEW RD, STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 7.80% |
| IVAN HINRICHS3 | 6000 FAIRVIEW ROAD, STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $52 | $52 | 0.38% |
| GREG HINIRICHS3 | SOUTHPARK TOWERS SUITE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $25 | $88 | 17.60% |
| DANIEL WARD RICHARDSON3 Filed as: DANIEL W RICHARDSON | 6000 FAIRVIEW ROAD STE 410 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $61 | — | $61 | 12.20% |
| JAMES W DEUINK3 | SOUTHPARK TOWERS 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $61 | — | $61 | 12.20% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $1.2M |
| PASSPORT HEALTH EIN 20-5572188 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $80K |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $66K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $48K |
| CIGNA NONE | Insurance services; Direct payment from the plan Service code 23 | P.O. BOX 20643 LEHIGH VALLEY, PA 180020643 | $40K |
| BENEFITS EXPRESS EIN 37-1454096 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $26K |
| PLANTE MORAN EIN 38-1357951 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $24K |
| INTERACTIVE HEALTH EIN 36-3798756 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $10K |
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 | 1,699 | 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) | 1,699 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HMSA | 27 | $156K |
| Dental | HMSA | 27 | $156K |
| Vision | VISION SERVICE PLAN | 1,011 | $205K |
| Life insurance(3 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,960 | $1.3M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,779 | $50K |
| Long-term disability(4 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,960 | $1.1M |
| Other(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,960 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,960 | — |
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.