| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: VARIOUS AGENTS LIST ATTACHED | — | AFLAC | $33K | $1K | $35K | 15.95% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS LIST ATTACHED | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11K | $110 | $11K | 7.10% |
| BRIAN FOLEY3 | PO BOX 31817 CHARLOTTE CHARLOTTE, NC 28231 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $14K | — | $14K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 59-0894904 CLAIMS ADMINISTRATION | Claims processing Service code 12 | — | $943K |
| EMPLOYEE ASSISTANCE NETWORK INC EIN 20-5468358 EMPLOYEE ASSISTANCE PLAN | Other services Service code 49 | 417 BILTMORE AVE DOCTOR'S PARK SUITE 3-C ASHEVILLE, NC 28801 | $11K |
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 | 2,053 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,072 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 4,931 | $0 |
| Dental | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 4,931 | $0 |
| Vision | COMMUNITY EYE CARE | 2,543 | $100K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,811 | $1.4M |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,811 | $1.4M |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 4,811 | $1.2M |
| Other(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,811 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,931 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.