| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES A SCOTT & SON INC3 | PO BOX 603438 CHARLOTTE, NC 28260 | HARTFORD LIFE AND ACCIDENT | $114K | $8K | $122K | 23.90% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES, LLC | 4611 UNIVERSITY DR DURHAM, NC 27702 | HARTFORD LIFE AND ACCIDENT | $0 | $36K | $36K | 7.00% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT | $32K | $0 | $32K | 6.23% |
| SEAN WILLOUGHBY-RAY3 Filed as: SEAN R. WILLOUGHBY-RAY | 400 BELLEMEADE ST. STE 201 GREENSBORO, NC 27401 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $35K | $0 | $35K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 CLAIMS PROCESSOR | Insurance agents and brokers; Claims processing Service code 12 | 4615 UNIVERSITY DR DURHAM, NC 27707 | $389K |
| FLORES AND ASSOCIATES EIN 56-1542307 NONE | Legal Service code 29 | 1218 CHURCH ST CHARLOTTE, NC 28203 | $10K |
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 | 868 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 868 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 1,274 | $0 |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 868 | $29K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 829 | $509K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 829 | $509K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 829 | $509K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 1,274 | $0 |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 1,274 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,274 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.