| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERV USA INC (NC) | — | CIGNA | $36K | — | $36K | 13.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 7 GIRALDA MADISON, NJ 07940 | METROPOLITAN LIFE INSURANCE COMPANY | $18K | $27 | $18K | 12.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 1018 W 9TH AVE KING OF PRUSSIA, PA 19406 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 1.42% |
| LYNN GARRETT3 | 900 CAROLINA AVE DURHAM, NC 27705 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | — | $10K | 15.63% |
| BARRETT L PATTERSON3 Filed as: BARRETT PATTERSON | P.O. BOX 10641 RALEIGH, NC 27605 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $947 | $170 | $1K | 1.84% |
| JANIE M GREER3 Filed as: JANIE GREER | 124 CHATTERSON DRIVE RALEIGH, NC 27615 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 0.15% |
| WORKSITE BENEFIT SERVICES | 8133 ROBINCREST CT FUQUAY VARINA, NC 27526 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 0.05% |
| FREDERICK RAAB | 2904 DUNHAVEN DR GARNER, NC 27529 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.03% |
| MICHAEL L COUSINS3 Filed as: MICHAEL COUSINS | PO BOX 327 GARNER, NC 27529 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| JOHN SWIDERSKI3 | 3316 SINGLELEAF LANE RALEIGH, NC 27616 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| ARTHUR WAYNE JORDAN JR Filed as: ARTHUR WAYNE JORDAN, JR. | 514 OAKWOOD AVE RALEIGH, NC 27601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.00% |
| BENEFITS COUNT INC Filed as: BENEFITS COUNT LI INC | 1401 CHRISTIMAS COURT RALEIGH, NC 27604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.00% |
| LYNN GARRETT | 900 CAROLINA AVE DURHAM, NC 27705 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 10.77% |
| BARRETT L PATTERSON Filed as: BARRETT PATTERSON | PO BOX 10641 RALEIGH, NC 27605 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $273 | $32 | $305 | 1.09% |
| WORKSITE BENEFIT SERVICES | 8133 ROBINCREST CT FUQUAY VARINA, NC 27526 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | — | $50 | 0.18% |
| FREDERICK RAAB | 2904 DUNHAVEN DR GARNER, NC 27529 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.16% |
| JANIE M GREER Filed as: JANIE GREER | 124 CHATTERSON DRIVE RALEIGH, NC 27615 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.14% |
| MICHAEL L COUSINS Filed as: MICHAEL COUSINS | PO BOX 327 GARNER, NC 27529 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.06% |
| BENEFITS COUNT INC Filed as: BENEFITS COUNT LI INC | 1401 CHRISTIMAS COURT RALEIGH, NC 27604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $7 | $17 | 0.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Claims processing; Non-monetary compensation; Participant communication; Named fiduciary; Float revenue; Other services; Contract Administrator; Direct payment from the plan Service code 12 | — | $4K |
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 | 165 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA | 157 | $275K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 283 | $147K |
| Vision(2 contracts, 2 carriers) | CIGNA | 283 | $422K |
| Life insurance(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 283 | $236K |
| Short-term disability(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 283 | $236K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 283 | $147K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 283 | $147K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 283 | — |
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.