| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERIVCES | EMPLOYEE BENEFIT COMMISSIONS PO BOX 601478 CHARLOTTE, NC 28261 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $13K | — | $13K | 10.00% |
| WELLS FARGO INSURANCE SERVICES Filed as: WELLS FARGO INSURANCE SERVICES USA | PO BOX 203510 DALLAS, TX 75320 | VISION SERVICE PLAN | $2K | — | $2K | 3.27% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 601478 CHARLOTTE, NC 28261 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | — | $6K | 10.00% |
| WELLS FARGO INSURANCE SERVICES3 | EMPLOYEE BENEFITS COMMISSIONS PO BOX 601478 CHARLOTTE, NC 282611478 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHGRAM EIN 56-1449504 | Claims processing Service code 12 | PO BOX 11088 CHARLOTTE, NC 28220 | $178K |
| WELLS FARGO INSURANCE SERVICES EIN 41-0449260 | Consulting (general) Service code 16 | PO BOX 5351006 ATLANTA, GA 30353 | $38K |
| B. V. HEDRICK GRAVEL & SAND COMPANY EIN 56-0257665 PLAN SPONSOR | Plan Administrator; Accounting (including auditing) Service code 10 | PO BOX 1040 SALISBURY, NC 28145 | $24K |
| ANDERSON, SMITH & WIKE LLC EIN 27-1473864 | Accounting (including auditing) Service code 10 | 154 SOUTH HARBOR WATCH STATESVILLE, NC 28667 | $6K |
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 | 662 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 664 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 541 | $62K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 716 | $22K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 563 | $127K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 561 | $61K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORPORATION | 607 | $452K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 716 | — |
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.