| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MASON, DIANA M3 | PO BOX 10489 LYNCHBURG, VA 24506 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $62K | — | $62K | 1.55% |
| JAMES A SCOTT & SON INC3 | 628 GREEN VALLEY RD SUITE 306 GREENSBORO, NC 27408 | DELTA DENTAL OF NORTH CAROLINA | $29K | — | $29K | 9.89% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A SCOTT & SON, INC. | PO BOX 603438 CHARLOTTE, NC 28260 | HARTFORD LIFE AND ACCIDENT | $28K | — | $28K | 11.68% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES, LLC | 4611 UNIVERSITY DR DURHAM, NC 27702 | HARTFORD LIFE AND ACCIDENT | — | $18K | $18K | 7.58% |
| VARIOUS - SEE ATTACHED3 | — | AFLAC | $6K | $289 | $6K | 19.89% |
| RUTH A ANDERSON4 | 331 S FAYETTEVILLE ST CLAYTON, NC 27520 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $117 | — | $117 | 7.72% |
| KIM E LAMPLEY4 | 705 COVENTRY CT RALEIGH, NC 27609 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $69 | — | $69 | 4.55% |
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 | 457 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 459 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 590 | $4.0M |
| Dental | DELTA DENTAL OF NORTH CAROLINA | 711 | $290K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 272 | $33K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 649 | $244K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 649 | $244K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 649 | $244K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 590 | $4.0M |
| Other(4 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 649 | $286K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 711 | — |
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.