| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN M. HILTON3 Filed as: JOHN F. BURROWS | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | REGENCE BLUE CROSS BLUE SHIELD OF UTAH | $51K | — | $51K | 2.24% |
| JOHN M. HILTON3 Filed as: JOHN F. BURROWS | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | PRIORITY HEALTH | $22K | — | $22K | 1.97% |
| BENEFIT CONTROLS OF THE CAROLINAS3 | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | DELTA DENTAL OF MICHIGAN | $9K | — | $9K | 3.30% |
| USI INSURANCE SERVICES LLC3 | 201 ALHAMBRA CIR STE 801 CORAL GABLES, FL 33134 | DELTA DENTAL OF MICHIGAN | $4K | — | $4K | 1.46% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62889 CHARLOTTE, NC 28247 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | — | $12K | 14.73% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62889 VIRGINIA BEACH, VI 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 15.00% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62889 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 15.00% |
| JOHN M. HILTON3 Filed as: JOHN F. BURROWS | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | PRIORITY HEALTH | $1K | — | $1K | 1.98% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62889 VIRGINIA BEACH, VA 28247 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
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 | 428 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 440 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | REGENCE BLUE CROSS BLUE SHIELD OF UTAH | 521 | $3.4M |
| Dental | DELTA DENTAL OF MICHIGAN | 875 | $275K |
| Vision | VISION SERVICE PLAN | 330 | $57K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 428 | $80K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 428 | $61K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 428 | $59K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 428 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 875 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.