| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFFREY W PATTEN3 | 3318 WEST FRIENDLY AVE GREENSBORO, NC 27410 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $18K | $0 | $18K | 9.75% |
| CHARLOTTE GREY INC3 | 119 NORTH GREEN STREET STATESVILLE, NC 28877 | AFLAC | $23K | $576 | $24K | 13.06% |
| KIM J WILLIAMS3 Filed as: KIM WILLIAMS | 4406 FORREST VALLEY CIR VALDOSTA, GA 31602 | AFLAC | $4K | $115 | $4K | 2.41% |
| KATHERINE L SIMOS3 Filed as: KATHERINE SIMOS | 1605 CONRAD RD LEWISVILLE, NC 27023 | AFLAC | $3K | $30 | $3K | 1.53% |
| KIMBERLY MYERS3 | 257 PEOPLES CREEK RD ADVANCE, NC 27006 | AFLAC | $1K | $0 | $1K | 0.72% |
| LYNN W RACKEMANN3 Filed as: LYNN RACKEMANN | 1160 BROWDER FARM RD GERMANTON, NC 27019 | AFLAC | $1K | $0 | $1K | 0.60% |
| DEE W SLATER3 Filed as: DEE SLATER | 6847 WELLSLEY CT CLEMMONS, NC 27012 | AFLAC | $860 | $86 | $946 | 0.52% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: JOHN BROWN | PO BOX 501 JEFFERSON, NC 28640 | AFLAC | $584 | $0 | $584 | 0.32% |
| MARY E BECKER3 | 685 LAKEMONT TRAIL MOUNT AIRY, NC 27030 | AFLAC | $525 | $0 | $525 | 0.29% |
| PEGGY MORRIS3 | 2720 WOODLORE TRAIL WINSTON SALEM, NC 27103 | AFLAC | $473 | $0 | $473 | 0.26% |
| D AND V BUTLER INC3 Filed as: J BUTLER | 1440 OLD LENOIR RD STE A HICKORY, NC 28601 | AFLAC | $364 | $60 | $424 | 0.23% |
| MATTHEW G WILLIAMS3 Filed as: MATTHEW WILLIAMS | 2495 WILLIAMS RD LEWISVILLE, NC 27023 | AFLAC | $393 | $0 | $393 | 0.22% |
| JOANNE SCHERER3 | 1028 WATER LN JONESVILLE, NC 28642 | AFLAC | $321 | $0 | $321 | 0.18% |
| KELLY LEBSACK3 | 826 NORTH ELM ST GREENSBORO, NC 27401 | AFLAC | $258 | $0 | $258 | 0.14% |
| JAMES R HILL JR3 Filed as: JAMES HILL JR | 7021 MARSEILLES CT SUMMERFIELD, NC 27358 | AFLAC | $223 | $0 | $223 | 0.12% |
| DONNA N DWYER3 Filed as: DONNA WACHTER | 2072 1/2 S HAWTHORNE ROAD WINSTON SALEM, NC 27103 | AFLAC | $169 | $0 | $169 | 0.09% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: KATHY BROWN | PO BOX 501 JEFFERSON, NC 28840 | AFLAC | $40 | $0 | $40 | 0.02% |
| AIMEE WAGONER3 | PO BOX 826 DOBSON, NC 27017 | AFLAC | $31 | $0 | $31 | 0.02% |
| TERESA L SELLS3 Filed as: TERESA SELLS | PO BOX 84 WEST JEFFERSON, NC 28694 | AFLAC | $11 | $0 | $11 | 0.01% |
| JASON BRYANT3 | 165 PERIWINKLE LN STATE ROAD, NC 28676 | AFLAC | $9 | $0 | $9 | 0.00% |
| SIMERSON & ASSOCIATES INC3 | 3810 SOWERS ROAD LINWOOD, NC 27299 | AFLAC | $4 | $0 | $4 | 0.00% |
| THOMAS L LUEBCHOW3 Filed as: THOMAS LUEBCHOW | 390 PILOT RIDGE DR LEWISVILLE, NC 27023 | AFLAC | $3 | $0 | $3 | 0.00% |
| EXSEPTIONAL SERVICES INC3 | 158 PRINTERS LN NEW LONDON, NC 28127 | AFLAC | $2 | $0 | $2 | 0.00% |
| LARRY W NICHOLSON3 | 636 N TREZEVANT ST MEMPHIS, TN 38112 | AFLAC | $1 | $0 | $1 | 0.00% |
| BB&T INSURANCE SERVICES, INC.3 Filed as: BB&T INSURANCE SERVICES INC | 1020 DRAYTON STREET 2ND FLOOR SUITE 200 SAVANAH, GA 31401 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 4.89% |
| CHARLOTTE H GREY3 | 119 NORTH GREEN STREET STATESVILLE, NC 28677 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7K | $0 | $7K | 13.16% |
| KIM J WILLIAMS3 | 4406 FOREST VALLEY CIRCLE VALDOSTA, GA 31602 | CONTINENTAL AMERICAN INSURANCE COMPANY | $976 | $0 | $976 | 1.92% |
| KATHERINE L SIMOS3 | 3309 CLARICE AVE PFAFFTOWN, NC 27040 | CONTINENTAL AMERICAN INSURANCE COMPANY | $966 | — | $966 | 1.90% |
| KIMBERLY MYERS3 Filed as: KIMBERLY S MYERS | 257 PEOPLES CREEK RD ADVANCE, NC 27006 | CONTINENTAL AMERICAN INSURANCE COMPANY | $663 | $0 | $663 | 1.31% |
| JAMES R HILL JR3 | 7021 MARSEILLES CT SUMMERFIELD, NC 27358 | CONTINENTAL AMERICAN INSURANCE COMPANY | $136 | $0 | $136 | 0.27% |
| RUSSELL W TINNEY3 | 824 S MILLS RD MOYOCK, NC 27958 | CONTINENTAL AMERICAN INSURANCE COMPANY | $40 | $0 | $40 | 0.08% |
| ERIC MILLER3 | 6631 FOX RIDGE CIRCLE DAVIDSON, NC 28036 | CONTINENTAL AMERICAN INSURANCE COMPANY | $40 | $0 | $40 | 0.08% |
| TERESA L SELLS3 Filed as: TERESA SELLS | PO BOX 84 WEST JEFFERSON, NC 28694 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | $0 | $9 | 0.02% |
| BRANDON C ADAMS3 | 6402 BIRKDALE DR GREENSBORO, NC 27410 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
| BB&T INSURANCE SERVICES, INC.3 Filed as: BB&T INSURANCE SERVICES INC | 3318 WEST FRIENDLY AVE GREENSBORO, NC 27410 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $323 | $323 | 2.78% |
| BB&T INSURANCE SERVICES, INC.3 Filed as: BB&T INSURANCE SERVICES INC | 3318 WEST FRIENDLY AVE GREENSBORO, NC 27410 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $634 | $173 | $807 | 12.73% |
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 | 197 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 388 | $189K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 189 | $108K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 189 | $108K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 225 | $187K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 188 | $12K |
| Other(3 contracts, 3 carriers) | AFLAC | 225 | $238K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 388 | — |
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.