| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHELLEY L MCLEAN3 Filed as: SHELLEY L. MCLEAN | 6525 MORRISON BLVD SUITE 215 CHARLOTTE, NC 28211 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | — | $1K | $1K | — |
| BENEFITS COUNT INC3 Filed as: BENEFITS COUNT 1 INC | 248 RIVERWOOD DR LEWISVILLE, NC 27023 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $723 | $18 | $741 | — |
| D.L. DAVIS & COMPANY INC.3 Filed as: D.L. DAVIS & CO, INC | 1111 S MARSHALL ST WINSTON SALEM, NC 27101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $601 | — | $601 | — |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $334 | $9 | $343 | — |
| TURNKEY BENEFIT INSURANCE SERVICES3 Filed as: TURNKEY BENEFITS | 534 RIVERCROSSING DR FORT MILL, SC 29715 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $208 | — | $208 | — |
| SUE S. WARDEN3 Filed as: SUE S WARDEN | 1111 S MARSHALL ST WINSTON SALEM, NC 27101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $168 | — | $168 | — |
| INSYNC BENEFITS INC3 Filed as: INSYNC BENEFITS | PO BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | — | $102 | — |
| BENEFITS COUNT INC3 Filed as: BENEFITS COUNT 1I INC | 1401 CHRISTMAS CT RALEIGH, NC 27604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | $18 | $67 | — |
| RYLEE ENTERPRISES INC3 | 1828 OAK RIDGE RD OAK RIDGE, NC 27310 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | — | $59 | — |
| ARTHUR WAYNE JORDAN JR3 Filed as: ARTHUR WAYNE JORDAN | 514 OAKWOOD AVE RALEIGH, NC 27601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | $9 | $47 | — |
| UN HUI SMITH3 | PO BOX 1722 DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | — |
| ROBERT P MCFARLAND3 | 6739 MOUNTAIN MAJESTY WAY HUNTERSVILLE, NC 28078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | — | $28 | — |
| CAROLINA BENEFITS SOURCE INC3 | 4461 NE 30TH AVE LIGHTHOUSE POINT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | — |
| JOHN J SWIDERSKI3 | 3316 SINGLELEAF LN RALEIGH, NC 27616 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $2 | $11 | — |
| BRIAN FLANNERY3 | 183 WINDSOR GREEN DRIVE CLAYTON, NC 27527 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | — |
| BARRETT L PATTERSON3 | PO BOX 10641 RALEIGH, NC 27605 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | — |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | — | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $6K | $6K | — |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | — |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 400 GALLERIA PKWY SUITE 300 ATLANTA, GA 30339 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | — |
| TURNKEY BENEFIT INSURANCE SERVICES3 Filed as: TURNKEY BENEFIT INSURANCE SVCS, INC | PO BOX 55210 INDIANAPOLIS, IN 46205 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $144 | — | $144 | — |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 400 GALLERIA PKWY SUITE 300 ATLANTA, GA 30339 | AMERICA UNITED LIFE INSURANCE COMPANY | $5K | $901 | $6K | — |
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 | 116 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 180 | $0 |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 141 | $0 |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 119 | $0 |
| Long-term disability | AMERICA UNITED LIFE INSURANCE COMPANY | 119 | $0 |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 180 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.