| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 1120 S. TRYON ST. #650 CHARLOTTE, NC 28203 | AMERITAS LIFE INSURANCE COMPANY | $45K | — | $45K | 5.55% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 240 NORTH TRYON STREET SUITE 2500 CHARLOTTE, NC 28282 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $48K | — | $48K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES | PO BOX 101162 PASADENA, CA 91189 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 1.52% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905643 CHARLOTTE, NC 28290 | RELIASTAR LIFE INSURANCE COMPANY | $29K | — | $29K | 20.33% |
| AFFINITY LTC, LLC3 | 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $3K | — | $3K | 2.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $2K | — | $2K | 1.97% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PLACE CHICAGO, IL 606731297 | METLIFE LEGAL PLANS | $2K | — | $2K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 13784 NEWARK, NJ 07188 | METLIFE LEGAL PLANS | — | $180 | $180 | 0.73% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 3000 BAYPORT DRIVE SUITE 300 TAMPA, FL 33607 | METLIFE LEGAL PLANS | — | $180 | $180 | 0.73% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE, INC. | 265 BROOKVIEW CENTRE WAY SUITE 505 KNOXVILLE, TN 37919 | METLIFE LEGAL PLANS | — | $51 | $51 | 0.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | JP MORGAN CHASE 806 TYVOLA RD, STE 108 CHARLOTTE, NC 28217 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $4K | — | $4K | 25.00% |
| BLTC FUNDING/PKA AFFINITY LLC3 | 6201 PRESIDENTIAL CT FT. MYERS, FL 33919 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 16.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NORTH CAR EIN 56-0894904 CLAIMS PROCESSOR | Claims processing; Insurance agents and brokers Service code 12 | — | $548K |
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 | 985 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 986 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE COMPANY | 1,782 | $816K |
| Vision | AMERITAS LIFE INSURANCE COMPANY | 1,782 | $816K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 993 | $499K |
| Long-term disability | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 993 | $483K |
| Other(7 contracts, 7 carriers) | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 1,037 | $791K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,782 | — |
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.