| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELISSA MURBACH3 Filed as: MELISSA E MURBACH | 1105 LAUREL AVE KING, NC 27021 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | — | $5K | 5.29% |
| BANKERS INSURANCE LLC4 | 4490 COX ROAD GLEN ALLEN, VA 23060 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 1.51% |
| JEREMY M HASKELL3 Filed as: JEREMY HASKELL | 2150 COUNTRY CLUB ROAD, STE 228 WINSTON-SALEM, NC 27104 | CONTINENTAL AMERICAN INSURANCE COMPANY | $865 | — | $865 | 0.94% |
| KELLY LEBSACK3 Filed as: KELLY D LEBSACK | 3300 BATTLEGROUND AVE. #206 GREENSBORO, NC 27410 | CONTINENTAL AMERICAN INSURANCE COMPANY | $496 | — | $496 | 0.54% |
| LORI A WILLIAMS3 | 45 OXFORD DRIVE MARTINSVILLE, VA 24112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $175 | — | $175 | 0.19% |
| MIKE BUTLER3 | 1090 13TH AVE NW HICKORY, NC 28601 | CONTINENTAL AMERICAN INSURANCE COMPANY | $150 | — | $150 | 0.16% |
| JAMES R HILL JR3 Filed as: JAMES R HILL JR. | 7021 MARSEILLES CT SUMMERFIELD, NC 27358 | CONTINENTAL AMERICAN INSURANCE COMPANY | $120 | — | $120 | 0.13% |
| TREVOR G MURBACH3 | 1105 LAUREL BLUFF DR KING, NC 27021 | CONTINENTAL AMERICAN INSURANCE COMPANY | $79 | — | $79 | 0.09% |
| DIANA A TATE3 | 701 SIMPSONS ST GREENSBORO, NC 27401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $76 | — | $76 | 0.08% |
| KATRINA D AIKEN3 | 3462 38TH ST DR NE HICKORY, NC 28601 | CONTINENTAL AMERICAN INSURANCE COMPANY | $52 | — | $52 | 0.06% |
| DEBORAH A WITHEY3 | 2155 6TH ST NE HICKORY, NC 28601 | CONTINENTAL AMERICAN INSURANCE COMPANY | $46 | — | $46 | 0.05% |
| MELANIE ZEBRON3 | 1101 CLYDE EDGERTON DRIVE KERNERSVILLE, NC 27284 | CONTINENTAL AMERICAN INSURANCE COMPANY | $44 | — | $44 | 0.05% |
| GREENPOINT INSURANCE GROUP INC3 Filed as: GREENPOINT INSURANCE GROUP INC. | 711 GALLIMOR DAIRY ROAD HIGHPOINT, NC 27265 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25 | — | $25 | 0.03% |
| FRANKLIN TRAVIS BLACK3 Filed as: FRANKLIN BLACK | 5981 WOODFIELD DRIVE KERNERSVILLE, NC 27284 | CONTINENTAL AMERICAN INSURANCE COMPANY | $22 | — | $22 | 0.02% |
| FRANKLIN TRAVIS BLACK3 Filed as: FRANKLIN BLACK | 5981 WOODFIELD DRIVE KERNERSVILLE, NC 27284 | CONTINENTAL AMERICAN INSURANCE COMPANY | $19 | — | $19 | 0.02% |
| TRACI BATTOEN3 | 4110 SOUTHPOINT BLVD RD JACKSONVILLE, FL 32216 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | — | $16 | 0.02% |
| KATHERINE L SIMOS3 | 3309 CLARICE AVE PFAFFTOWN, NC 27040 | CONTINENTAL AMERICAN INSURANCE COMPANY | $13 | — | $13 | 0.01% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M MILLER | 6631 FOX RIDGE CIRCLE DAVIDSON, NC 28036 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.01% |
| ELIZABETH CUSHING3 | 9 WATER GARDEN WAY DURHAM, NC 27713 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.01% |
| GREGORY E MEYER3 | 1582 RUNNING DEER DR KERNERSVILLE, NC 27284 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.01% |
| ROBERT LYNN ASHLEY3 | 311 FALLS DRIVE ABINGDON, VA 24210 | AMERICAN HERITAGE LIFE INSURANCE | $240 | — | $240 | 1.35% |
| WILLIAM E CAMPBELL3 | 512 STRALEY AVE PRINCETON, WV 24740 | AMERICAN HERITAGE LIFE INSURANCE | $89 | — | $89 | 0.50% |
| WALLER DOROTHY C3 Filed as: WALLER, DOROTHY C | 640 8TH STREET NE PULASKI, VA 24301 | AMERICAN HERITAGE LIFE INSURANCE | $18 | — | $18 | 0.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHGRAM, INC. EIN 56-1449504 | Plan Administrator Service code 14 | — | $198K |
| CIGNA CORPORATION EIN 59-1031071 | Plan Administrator Service code 14 | — | $84K |
| CAREOPERATIVE, LLC EIN 20-8981027 | Plan Administrator Service code 14 | — | $8K |
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 | 465 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 470 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMERICAN HERITAGE LIFE INSURANCE | 55 | $18K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 463 | $1.3M |
| Other(2 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 304 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.