| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLOUNT, CHRISTOPHER3 | 1667 DAVIE AVE STATESVILLE, NC 28677 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $28K | — | $28K | 2.45% |
| GEOFFREY RICKS3 | 18616 MAPLECROFT LAKE LN DAVIDSON, NC 28036 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $18K | — | $18K | 1.59% |
| D. RYDER WITTER IV3 | 100 SUMMIT LAKE DR STE 400 VALHALLA, NY 10595 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $4K | — | $4K | 0.39% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62819 VIRGINIA BEACH, VA 23466 | PRINCIPAL LIFE INSURANCE COMPANY | $18K | $2K | $20K | 10.19% |
| PIEDMONT BENEFITS GROUP, INC.3 Filed as: PIEDMONT BENEFITS GROUP INC | 18809 W CATAWBA AVE STE 101 CORNELIUS, NC 28031 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 4.68% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES LLC | PO BOX 2291 DURHAM, NC 27702 | PRINCIPAL LIFE INSURANCE COMPANY | — | $6K | $6K | 3.05% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | — | $4K | 5.85% |
| PIEDMONT BENEFITS GROUP, INC.3 Filed as: PIEDMONT BENEFITS GROUP, INC | 18809 W CATAWBA AVE STE 101 CORNELIUS, NC 28031 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 3.25% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 277 | $1.1M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 244 | $192K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 244 | $192K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 244 | $192K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 244 | $192K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 277 | $1.1M |
| Other(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 277 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 277 | — |
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.