| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT T ROBERTS3 | PO BOX 997 LILLINGTON, NC 27546 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $32K | — | $32K | 1.17% |
| TRI-CO INSURANCE AGENCY3 Filed as: TRI-CO INC | PO BOX 997 LILLINGTON, NC 27546 | METROPOLITAN LIFE INSURANCE COMPANY | $20K | $3K | $23K | 11.52% |
| BENEFIT CHOICES INC DHI3 | PO BOX 1588 PINEHURST, NC 28370 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 10.69% |
| REGENCY 21 INSURANCE AGENCY INC3 | 4928 LINKSLAND DR HOLLY SPRINGS, NC 27540 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 2.21% |
| PIERCE GROUP BENEFITS LLC3 | 4928 LINKSLAND DR HOLLY SPRINGS, NC 27540 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $432 | — | $432 | 0.80% |
| STATE EMPLOYEE BENEFITS LLC3 | PO BOX 365 HOPE MILLS, NC 28348 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $344 | — | $344 | 0.64% |
| KEVIN J MILLER3 Filed as: KEVIN MILLER | 45 PINEVALLEY LN SANFORD, NC 27332 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $210 | — | $210 | 0.39% |
| WILLIAM A BURNETTE3 Filed as: WILLIAM BURNETTE | PO BOX 785 BENSON, NC 27504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $90 | — | $90 | 0.17% |
| BARRETT L PATTERSON3 | PO BOX 10641 RALEIGH, NC 27605 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $65 | — | $65 | 0.12% |
| AMY C WARREN3 Filed as: AMY WARREN | 703 OLDWYCK DR FUQUAY VARINA, NC 27526 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.04% |
| WARREN CONSULTING GROUP INC3 | 703 OLDWYCK DR FUQUAY VARINA, NC 27526 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.04% |
| ROBERT TAYLOR GROUP INC3 | PO BOX 2000 WINTERVILLE, NC 28590 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.03% |
| FRED RAAB3 | 2904 DUNHAVEN DR GARNER, NC 27529 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.03% |
| ROBERT WOODFIN3 | 2401 FRASERBURGH DR MATTHEWS, NC 28105 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.03% |
| WOODFIN INSURANCE GROUP INC3 | 2401 FRASERBURGH DR MATTHEWS, NC 28105 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.03% |
| JIMMY JONES3 | 2200 CUSTOMS HOUSE CT RALEIGH, NC 27615 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| TRI-CO INSURANCE AGENCY3 Filed as: TRI-CO | PO BOX 997 LILLINGTON, NC 27546 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 9.12% |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 387 | $2.8M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 420 | $197K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 387 | $2.7M |
| Life insurance | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 94 | $54K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 94 | $54K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 387 | $2.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 420 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.