| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | PO BOX 31817 CHARLOTTE, NC 28231 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $36K | — | $36K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | PO BOX 31817 CHARLOTTE, NC 28231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | $16K | $28K | 8.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | PO BOX 31817 CHARLOTTE, NC 28231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | $13K | $24K | 7.76% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA | PO BOX 31817 CHARLOTTE, NC 28231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $9K | $16K | 7.71% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | PO BOX 31817 CHARLOTTE, NC 28231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $605 | $774 | $1K | 7.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 | Named fiduciary; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Participant communication Service code 12 | 11016 RUSHMORE DRIVE SUITE 300 CHARLOTTE, NC 28277 | $950K |
| CORPORATE CHAPLAINS OF AMERICA EIN 56-1966466 | Contract Administrator Service code 13 | PO BOX 63107 CHARLOTTE, NC 28263 | $51K |
| WILLIS OF NORTH CAROLINA EIN 56-1671375 | Consulting (general) Service code 16 | PO BOX 31817 CHARLOTTE, NC 28282 | $40K |
| 1-800MD, LLC EIN 27-1532190 | Contract Administrator Service code 13 | 6408 BANNINGTON ROAD CHARLOTTE, NC 28226 | $25K |
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 | 1,808 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 22 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,830 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 2,116 | $724K |
| Vision | VISION SERVICE PLAN | 1,707 | $255K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,209 | $346K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,031 | $213K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,010 | $313K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,745 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,209 | — |
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.