| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GLENN WINTERS INSURANCE AGENCY3 Filed as: GLENN WINTERS | 5581 BROOKWOOD LN HICKORY, NC 28602 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $7K | — | $7K | 1.49% |
| JUDITH CULLER3 | 131 ENGLEWOOD DR ARCHDALE, NC 27263 | AFLAC | $643 | $68 | $711 | 3.94% |
| GERALD HILL AND ASSOCIATES3 | 612 PASTEUR DR SUITE 100 GREENSBORO, NC 27403 | AFLAC | $502 | $14 | $516 | 2.86% |
| C HARVEY KING3 | PO BOX 45 WEST JEFFERSON, NC 28694 | AFLAC | $160 | — | $160 | 0.89% |
| DANIEL E BULLUCK3 | 3631 REDFIELD DR GREENSBORO, NC 27410 | AFLAC | $151 | — | $151 | 0.84% |
| MAUREEN E PETERSON3 | PO BOX 39462 GREENSBORO, NC 27438 | AFLAC | $146 | — | $146 | 0.81% |
| JOHN ARIANSEN3 | PO BOX 18214 GREENSBORO, NC 27419 | AFLAC | $110 | $13 | $123 | 0.68% |
| J MICHAEL BUTLER3 | 1440 OLD LENOIR RD STE A HICKORY, NC 28601 | AFLAC | $115 | — | $115 | 0.64% |
| JAMES R HILL JR3 | 7021 MARSEILLES CT SUMMERFIELD, NC 27358 | AFLAC | $37 | $13 | $50 | 0.28% |
| KATHY HILL3 Filed as: KATHY B HILL | 8806 DAPPLE GREY RD OAK RIDGE, NC 27310 | AFLAC | $40 | — | $40 | 0.22% |
| BETTY C PAYNE3 | 2771 UPPER PAW PAW RD MARSHALL, NC 28753 | AFLAC | $29 | — | $29 | 0.16% |
| JENNY L T NELSON3 | PO BOX 1066 NORTH WILKESBORO, NC 28659 | AFLAC | $28 | — | $28 | 0.16% |
| LARRY DEAN CHESTNUTT JR3 | 44 NEVADA AVE ASHEVILLE, NC 28806 | AFLAC | $26 | — | $26 | 0.14% |
| JOHNNA G ONTKO3 | 203 ELWOOD ST KANNAPOLIS, NC 28081 | AFLAC | $24 | — | $24 | 0.13% |
| ELIZABETH F HARKEY3 | 501 N CHURCH ST STE 300 CHARLOTTE, NC 28202 | AFLAC | $20 | — | $20 | 0.11% |
| TERRY J SILVERS3 | 100 GREENLEAF DR FLAT ROCK, NC 28731 | AFLAC | $15 | — | $15 | 0.08% |
| JANE W FAUST3 | 398 CRESTSIDE DR SE CONCORD, NC 28025 | AFLAC | $13 | — | $13 | 0.07% |
| MELISSA K SWAN3 | 204 S 35TH ST STE 100 COUNCIL BLUFFS, IA 51501 | AFLAC | $8 | — | $8 | 0.04% |
| KELLY LEBSACK3 Filed as: KELLY D LEBSACK | 826 NORTH ELM ST STE 206 GREENSBORO, NC 27401 | AFLAC | $7 | — | $7 | 0.04% |
| LARRY A WESTON JR3 | 321 WINDSOR RD GREENVILLE, NC 27858 | AFLAC | $6 | — | $6 | 0.03% |
| NEIL M MORGAN JR3 | 1904 ELLIS DR MAIDENS, VA 23102 | AFLAC | $2 | — | $2 | 0.01% |
| WINTERS, GLENN R3 | 5581 BROOKWOOD LANE HICKORY, NC 28602 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $850 | — | $850 | 10.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SAVERS ADMINISTRATIVE SERVICES EIN 57-1177739 NONE | Claims processing Service code 12 | — | $13K |
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 | 256 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 256 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 445 | $454K |
| Dental | AFLAC | 33 | $18K |
| Vision | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 101 | $8K |
| Life insurance | AFLAC | 33 | $18K |
| Short-term disability | AFLAC | 33 | $18K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 445 | $446K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 445 | $446K |
| Other(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 445 | $464K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 445 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.