| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEALTHGRAM INC3 Filed as: HEALTHGRAM INC. | P.O. BOX 11088 CHARLOTTE, NC 282201088 | HM LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| MELISSA MURBACH3 Filed as: MELISSA E MURBACH | 1105 LAUREL AVE KING, NC 27021 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | — | $5K | 5.19% |
| GREENPOINT INSURANCE GROUP INC3 | 711 GALLIMORE DAIRY RD HIGH POINT, NC 27265 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 3.30% |
| KELLY LEBSACK3 Filed as: KELLY D LEBSACK | 3300 BATTLEGROUND AVE. #206 GREENSBORO, NC 27410 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 1.26% |
| WORKSITE ASSOCIATES LLC3 | 2307 WEST CONE BOULEVARD SUITE 110 GREENSBORO, NC 27408 | CONTINENTAL AMERICAN INSURANCE COMPANY | $763 | — | $763 | 0.79% |
| LINKEDAGENCY LLC3 | 9820 NORTH CROSS CENTER HUNTERSVILLE, NC 28078 | CONTINENTAL AMERICAN INSURANCE COMPANY | $510 | — | $510 | 0.53% |
| LORI A WILLIAMS3 | 45 OXFORD DRIVE MARTINSVILLE, VA 24112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $256 | — | $256 | 0.27% |
| MIKE BUTLER3 | 1090 13TH AVE NW HICKORY, NC 28601 | CONTINENTAL AMERICAN INSURANCE COMPANY | $236 | — | $236 | 0.25% |
| JAMES R HILL JR3 Filed as: JAMES R HILL JR. | 7021 MARSEILLES CT SUMMERFIELD, NC 27358 | CONTINENTAL AMERICAN INSURANCE COMPANY | $152 | — | $152 | 0.16% |
| DIANA A TATE3 | 701 SIMPSONS ST GREENSBORO, NC 27401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $115 | — | $115 | 0.12% |
| KATRINA D AIKEN3 | 3462 38TH ST DR NE HICKORY, NC 28601 | CONTINENTAL AMERICAN INSURANCE COMPANY | $88 | — | $88 | 0.09% |
| TREVOR G MURBACH3 | 1105 LAUREL BLUFF DR KING, NC 27021 | CONTINENTAL AMERICAN INSURANCE COMPANY | $79 | — | $79 | 0.08% |
| DEBORAH A WITHEY3 | 2155 6TH ST NE HICKORY, NC 28601 | CONTINENTAL AMERICAN INSURANCE COMPANY | $74 | — | $74 | 0.08% |
| MELANIE ZEBRON3 | 1101 CLYDE EDGERTON DRIVE KERNERSVILLE, NC 27284 | CONTINENTAL AMERICAN INSURANCE COMPANY | $45 | — | $45 | 0.05% |
| FRANKLIN TRAVIS BLACK3 Filed as: FRANKLIN BLACK | 5981 WOODFIELD DRIVE KERNERSVILLE, NC 27284 | CONTINENTAL AMERICAN INSURANCE COMPANY | $23 | — | $23 | 0.02% |
| FRANKLIN TRAVIS BLACK3 Filed as: FRANKLIN BLACK | 5981 WOODFIELD DRIVE KERNERSVILLE, NC 27284 | CONTINENTAL AMERICAN INSURANCE COMPANY | $23 | — | $23 | 0.02% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M MILLER | 6631 FOX RIDGE CIRCLE DAVIDSON, NC 28036 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | — | $12 | 0.01% |
| ELIZABETH CUSHING3 | 9 WATER GARDEN WAY DURHAM, NC 27713 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | — | $12 | 0.01% |
| ROBERT LYNN ASHLEY3 | 311 FALLS DRIVE ABINGDON, VA 24210 | AMERICAN HERITAGE LIFE INSURANCE | $1K | — | $1K | 1.72% |
| WILLIAM E CAMPBELL3 | 512 STRALEY AVE PRINCETON, WV 24740 | AMERICAN HERITAGE LIFE INSURANCE | $279 | — | $279 | 0.36% |
| ROBERT LYNN ASHLEY3 Filed as: ROBERT L ASHLEY | P.O. BOX 722 ABINGDON, VA 242120722 | AMERICAN HERITAGE LIFE INSURANCE | $79 | — | $79 | 0.10% |
| DOROTHY C WALLER3 | 640 8TH STREET NE PULASKI, VA 24301 | AMERICAN HERITAGE LIFE INSURANCE | $59 | — | $59 | 0.08% |
| SOUTHERN SECURITY SPEC SVCS3 | 4813 COUGAR TRAIL RD DUBLIN, VA 24084 | AMERICAN HERITAGE LIFE INSURANCE | $56 | — | $56 | 0.07% |
| ROBERT LYNN ASHLEY3 Filed as: ROBERT ASHLEY | P.O. BOX 722 ABINGDON, VA 242120722 | AMERICAN HERITAGE LIFE INSURANCE | $53 | — | $53 | 0.07% |
| BOWLES ASSOC INC3 | P.O. BOX 700 FORK UNION, VA 23055 | AMERICAN HERITAGE LIFE INSURANCE | $18 | — | $18 | 0.02% |
| JAMES E. PERKINS3 Filed as: JAMES E PERKINS | 2205 LONG DRIVE ROCKVILLE, VA 23146 | AMERICAN HERITAGE LIFE INSURANCE | $11 | — | $11 | 0.01% |
| ROBERT LYNN ASHLEY3 | 311 FALLS DRIVE ABINGDON, VA 24210 | AMERICAN HERITAGE LIFE INSURANCE | $6 | — | $6 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHGRAM, INC. EIN 56-1449504 | Plan Administrator Service code 14 | — | $192K |
| CIGNA EIN 59-1031071 | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $82K |
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 | 614 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 30 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 644 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN HERITAGE LIFE INSURANCE | 43 | $77K |
| Life insurance | AMERICAN HERITAGE LIFE INSURANCE | 43 | $77K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 470 | $633K |
| Other | CONTINENTAL AMERICAN INSURANCE COMPANY | 276 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 470 | — |
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.