| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT E LOWDER3 | 609 HAZEL WOOD DR ALBEMARLE, NC 28001 | GUARDIAN | $6K | $0 | $6K | 6.83% |
| JOHNNY C HUNEYCUTT3 Filed as: JOHNNY C HUNNEYCUTT | PO BOX 520 BADIN, NC 28009 | GUARDIAN | $4K | $0 | $4K | 4.55% |
| TUCKER BOYNTON COMPANY INC3 | 3731 LATROBE DRIVE STE 200 CHARLOTTE, NC 28211 | USABLE LIFE | $1K | $0 | $1K | 10.00% |
| MOSAIC GROUP SERVICES3 | P.O. BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $718 | $0 | $718 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 CLAIMS PROVIDER | Claims processing Service code 12 | — | $56K |
| MARK S BOYNTON BROKER | Insurance agents and brokers Service code 22 | 3731 LATROBE DRIVE, STE 200 CHARLOTTE, NC 28211 | $26K |
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 | 160 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 105 | $518K |
| Dental | GUARDIAN | 104 | $88K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN | 160 | $103K |
| Short-term disability | GUARDIAN | 104 | $88K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 160 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.