| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DALE K. MOORE3 Filed as: DALE K MOORE | PO BOX 220748 CHARLOTTE, NC 28222 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $24K | — | $24K | 2.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 6100 FAIRVIEW RD STE 1400 CHARLOTTE, NC 282103293 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | $27 | $9K | 7.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | PO BOX 203510 IRVING, TX 75063 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $27 | $3K | 2.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 1018 W 9TH AVE KING OF PRUSSIA, PA 194061225 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.84% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | PO BOX 203491 DALLAS, TX 75320 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $11K | — | $11K | 66.61% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 6100 FAIRVIEW ROAD CHARLOTTE, NC 28210 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $118 | $0 | $118 | 8.94% |
| INSYNC BENEFITS INC3 | PO BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $77 | $27 | $104 | 7.88% |
| NANCY BAUCOM3 | 940-12 JETTON ST DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | $0 | $41 | 3.11% |
| PATRICIA L CARON3 | 816 BIG INDIAN LOOP MOORESVILLE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | $5 | $33 | 2.50% |
| SUSAN FONTENOT3 | 10717 DAPPLE GREY LANE CHARLOTTE, NC 28213 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $1 | $23 | 1.74% |
| KJELL T TERRELL3 Filed as: KJELL TERRELL | 327 GOLF COURSE DR RALEIGH, NC 27610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.38% |
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 | 163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 264 | $911K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 254 | $131K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 254 | $132K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 254 | $131K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 254 | $131K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 264 | $911K |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 254 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.