| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| D.L. DAVIS & COMPANY INC.3 | 1111 SOUTH MARSHALL ST., SUITE 250 WINSTON SALEM, NC 27101 | HARTFORD LIFE AND ACCIDENT | $205K | $17K | $222K | 3.25% |
| D.L. DAVIS & COMPANY INC.3 | 1111 SOUTH MARSHALL ST., SUITE 250 WINSTON SALEM, NC 27101 | HARTFORD LIFE AND ACCIDENT | $172K | $15K | $188K | 3.27% |
| D.L. DAVIS & COMPANY INC.3 | 1111 SOUTH MARSHALL ST., SUITE 250 WINSTON SALEM, NC 27101 | HARTFORD LIFE AND ACCIDENT | $128K | $11K | $139K | 3.25% |
| D.L. DAVIS & COMPANY INC.3 | 1111 SOUTH MARSHALL STREET, STE 250 WINSTON SALEM, NC 27101 | VISION SERVICE PLAN | $13K | — | $13K | 0.56% |
| D.L. DAVIS & COMPANY INC.3 | 1111 SOUTH MARSHALL ST., SUITE 250 WINSTON SALEM, NC 27101 | HARTFORD LIFE AND ACCIDENT | $43K | $3K | $47K | 3.25% |
| D.L. DAVIS & COMPANY INC.3 | 1111 SOUTH MARSHALL STREET, STE 250 WINSTON SALEM, NC 27101 | HARTFORD LIFE AND ACCIDENT | $132K | — | $132K | 15.00% |
| D.L. DAVIS & COMPANY INC.3 | 1111 SOUTH MARSHALL ST., SUITE 250 WINSTON SALEM, NC 27101 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $107K | — | $107K | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CONNECTICUT GENERAL LIFE INSURANCE CLAIMS PROCESSING | Participant communication; Named fiduciary; Other services; Non-monetary compensation; Claims processing; Contract Administrator; Float revenue; Direct payment from the plan Service code 12 | 5089 COLLECTION CENTER DR CHICAGO, IL 60693 | $10.7M |
| AON EIN 23-2293237 CONSULTING | Consulting (general) Service code 16 | — | $1.0M |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $578K |
| VSP EIN 06-1227840 CLAIMS PROCESSING | Claims processing Service code 12 | — | $275K |
| WOMBLE CARLYLE SANDRIDGE & RICE LLC EIN 56-0308470 LEGAL | Legal Service code 29 | — | $37K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 ACCOUNTING | Accounting (including auditing) Service code 10 | — | $22K |
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 | 20,047 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 240 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 20,287 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 15,003 | $2.3M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 20,369 | $5.7M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 11,501 | $4.3M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 17,822 | $6.8M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 9,079 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 20,369 | — |
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."
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.