| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ERIC W. BLACK3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $35K | $0 | $35K | 5.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | STARMOUNT LIFE INSURANCE COMPANY | $7K | $0 | $7K | 11.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4250 CONGRESS STREET, SUITE 200 CHARLOTTE, NC 28209 | STARMOUNT LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 WEST GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | STARMOUNT LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 11.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4250 CONGRESS STREET, SUITE 200 CHARLOTTE, NC 28209 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 4.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 WEST GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $712 | $712 | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4250 CONGRESS STREET, SUITE 200 CHARLOTTE, NC 28209 | HARTFORD LIFE AND ACCIDENT | $3K | $0 | $3K | 34.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | HARTFORD LIFE AND ACCIDENT | $0 | $189 | $189 | 2.06% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A. SCOTT & SON, INC. | PO BOX 603438 CHARLOTTE, NC 28260 | HARTFORD LIFE AND ACCIDENT | $11 | $0 | $11 | 0.12% |
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 | 97 | 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) | 97 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 167 | $614K |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 83 | $60K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 83 | $60K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $28K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $28K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $28K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 167 | $614K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.