| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | 15 JEFFERSON STREET ROANOKE, VA 24011 | SUN LIFE ASSURANCE COMPANY OF CANADA | $27K | $7K | $34K | 7.41% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA, INC. | PO BOX 32135 RICHMOND, VA 23294 | SUN LIFE ASSURANCE COMPANY OF CANADA | $19K | — | $19K | 4.15% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA INC. | 301 S TRYON STREET CHARLOTTE, NC 28282 | DELTA DENTAL OF NORTH CAROLINA | $8K | — | $8K | 4.54% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA INC. | PO BOX 31817 CHARLOTTE, NC 282311817 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $15K | — | $15K | 16.24% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA INC. | PO BOX 31817 CHARLOTTE, NC 282311817 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $13K | — | $13K | 16.24% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA INC. | PO BOX 31817 CHARLOTTE, NC 282311817 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $10K | — | $10K | 16.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA INC. | PO BOX 31817 CHARLOTTE, NC 282311817 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $8K | — | $8K | 16.38% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA INC. | PO BOX 31817 CHARLOTTE, NC 282311817 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $641 | — | $641 | 16.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH INSURANCE COMPANY EIN 59-1031071 CLAIM ADMINISTRATION | Direct payment from the plan; Contract Administrator; Claims processing; Named fiduciary; Float revenue; Non-monetary compensation; Other services; Participant communication Service code 12 | PO BOX 182223 CHATTANOOGA, TN 37422 | $317K |
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 | 724 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 724 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NORTH CAROLINA | 521 | $166K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 724 | $151K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 260 | $49K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 724 | $79K |
| Other(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 724 | $526K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 724 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.