| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN N. TOURNET3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $189K | $0 | $189K | 3.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 4TH FLOOR ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF NORTH CAROLINA | $59K | $0 | $59K | 14.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $50K | $0 | $50K | 14.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $4K | $4K | 1.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $23K | $0 | $23K | 15.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 1.26% |
| MJ INSURANCE3 Filed as: ROBERT OLSON AND VARIOUS AGENTS | 751 HEBRON PARKWAY, SUITE 220 LEWISVILLE, TX 75057 | AFLAC | $9K | $316 | $10K | 9.22% |
| JOHANN SCRIMSHIRE3 | 415 BLOOMFIELD ROAD SEBASTOPOL, CA 95472 | AFLAC | $3K | $0 | $3K | 2.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | AFLAC | $2K | $0 | $2K | 1.80% |
| AMY KLUTTZ3 | 2581 ESSEX DRIVE CONCORD, NC 28025 | AFLAC | $1K | $134 | $1K | 1.35% |
| DIANNE J RAY3 Filed as: DIANNE RAY | PO BOX 335 SUNNY SIDE, GA 30284 | AFLAC | $1K | $0 | $1K | 0.97% |
| MARK C. HUBER3 Filed as: MARK HUBER | 1260 NORTH DUTTON AVENUE, SUITE 180 SANTA ROSA, CA 95401 | AFLAC | $954 | $0 | $954 | 0.91% |
| THE PROFECTUS GROUP LLC3 Filed as: THE PROFECTUS GROUP, LLC | 2685 SOUTH RAINBOW BOULEVARD SUITE 200 LAS VEGAS, NV 89146 | AFLAC | $743 | $97 | $840 | 0.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | VISION SERVICE PLAN | $2K | $0 | $2K | 2.90% |
| CAROLINA BENEFITS SOURCE INC3 Filed as: CAROLINA BENEFITS SOURCE, INC. | 4461 NE 30TH AVENUE LIGHTHOUSE POINT, FL 33064 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $311 | $0 | $311 | 2.05% |
| EDWIN C. THORNE3 | 11523 CHESTNUT HILL DRIVE MATTHEWS, NC 28105 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $275 | $0 | $275 | 1.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4064 COLONY ROAD CHARLOTTE, NC 28211 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $186 | $0 | $186 | 1.23% |
| LAURIE J BURNS3 Filed as: LAURIE J. BURNS | 303 PLYLER ROAD INDIAN TRAIL, NC 28079 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $123 | $0 | $123 | 0.81% |
| ROBERT P MCFARLAND3 Filed as: ROBERT P. MCFARLAND | 111 NORTH PINE ISLAND DRIVE PLANTATION, FL 33324 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $117 | $0 | $117 | 0.77% |
| THE PLANNING GROUP AND OTHER AGENTS3 | PO BOX 8334 WILSON, NC 27893 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $65 | $0 | $65 | 0.43% |
| INSYNC BENEFITS INC3 Filed as: INSYNC BENEFITS, INC. | PO BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $0 | $60 | 0.40% |
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 | 780 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 792 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 947 | $6.0M |
| Dental | DELTA DENTAL OF NORTH CAROLINA | 935 | $403K |
| Vision | VISION SERVICE PLAN | 463 | $78K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $161K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $334K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $334K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 947 | $6.0M |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 131 | $603K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 947 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.