| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT A SKARTVEDT3 Filed as: ROBERT BIRDWELL | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $56K | $0 | $56K | 0.64% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 3731 S NOVA RD PORT ORANGE, FL 32129 | DELTA DENTAL OF NORTH CAROLINA | $36K | $0 | $36K | 6.13% |
| HAYS COMPANIES, INC.3 | 80 S 8TH ST MINNEAPOLIS, MN 55402 | DELTA DENTAL OF NORTH CAROLINA | $8K | $0 | $8K | 1.40% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | PO BOX 2412 DAYTONA BEACH, FL 32115 | DELTA DENTAL OF NORTH CAROLINA | $6K | $0 | $6K | 0.97% |
| SRA INSURANCE AGENCY LLC3 Filed as: SRA BENEFITS CONSULTING, LLC | 4700 SIX FORKS RD STE 200 RALEIGH, NC 27609 | DELTA DENTAL OF NORTH CAROLINA | $4K | $0 | $4K | 0.64% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | SYMETRA LIFE INSURANCE COMPANY | $40K | $7K | $47K | 8.80% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES LLC | 4615 UNIVERSITY DR DURHAM, NC 27707 | SYMETRA LIFE INSURANCE COMPANY | $27K | $0 | $27K | 4.99% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | SYMETRA LIFE INSURANCE COMPANY | $77K | $0 | $77K | 49.53% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES LLC | 4615 UNIVERSITY DR DURHAM, NC 27707 | SYMETRA LIFE INSURANCE COMPANY | $0 | $6K | $6K | 4.15% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | SYMETRA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 2.69% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 901 MARQUETTE AVE STE 1800 MINNEAPOLIS, MN 55402 | VISION SERVICE PLAN | $2K | $0 | $2K | 2.35% |
| WATCHTOWER TECHNOLOGIES INC3 | 306 W ERIE ST STE 300 CHICAGO, IL 60654 | VISION SERVICE PLAN | $1K | $0 | $1K | 1.47% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 901 MARQUETTE AVE STE 1800 MINNEAPOLIS, MN 55402 | VISION SERVICE PLAN | $1K | $0 | $1K | 1.34% |
| AGIS NETWORK INSURANCE SERVICES3 Filed as: AGIS NETWORK INS SVCS CORP | ONE BEACON STREET, #17100 BOSTON, MA 02108 | GENWORTH LIFE INSURANCE COMPANY | $5K | $0 | $5K | 8.75% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCCLENNAN AGENCY LLC | PO BOX 412703 BOSTON, MA 022412073 | GENWORTH LIFE INSURANCE COMPANY | $2K | $0 | $2K | 3.03% |
| AMERICAN BEN. AND COMP. SYS. INC.3 Filed as: AMERICAN BEN. & COMP. SYS. INC | 101 PARK AVE, 14TH FLOOR NEW YORK, NY 10178 | GENWORTH LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 80 SOUTH 8TH ST STE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 5.35% |
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 | 576 | 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) | 576 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 1,010 | $8.8M |
| Dental | DELTA DENTAL OF NORTH CAROLINA | 1,064 | $582K |
| Vision | VISION SERVICE PLAN | 440 | $88K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 576 | $535K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 576 | $535K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 576 | $535K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 1,010 | $8.8M |
| Other(4 contracts, 4 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 1,521 | $9.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,521 | — |
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.