| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACS BENEFIT SERVICES LLC3 Filed as: ACS BENEFIT SERVICES, LLC | 5660 UNIVERSITY PKWY., 5TH FL. WINSTON-SALEM, NC 27105 | HCC LIFE INSURANCE COMPANY | $4K | — | $4K | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACS BENEFIT SERVICES, LLC EIN 56-1472467 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | 5660 UNIVERSITY PKWY., 5TH FLOOR WINSTON SALEM, NC 27105 | $109K |
| THE HILB GROUP OF NORTH CAROLINA EIN 27-2838842 BROKER | Insurance brokerage commissions and fees Service code 53 | 530 N TRADE ST., STE. 302 WINSTON SALEM, NC 27101 | $49K |
| SELF FUNDING ACTUARIAL SERVICES EIN 56-1472476 ACTUARY | Actuarial Service code 11 | P.O. BOX 11166 WINSTON SALEM, NC 27116 | $300 |
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. |
| 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 266 | $50K |
| Stop-loss / reinsurancereinsurance | BRECKPOINT INSURANCE COMPANY LLC | 266 | $457K |
| Other | HCC LIFE INSURANCE COMPANY | 266 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 266 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.