| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT C. ANDERSON3 Filed as: SCOTT C ANDERSON | 6100 FAIRVIEW ROAD, SUITE 800 CHARLOTTE, NC 28222 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $62K | $0 | $62K | 2.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | P.O. BOX 203014 DALLAS, TX 75320 | CIGNA HEALTH AND LIFE INSURNACE COMPANY AND AFFILIATES | $17K | $0 | $17K | 7.93% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 400 HIGHWAY 169 SOUTH 8TH FLOOR ST LOUIS PARK, MN 55426 | USABLE LIFE | $10K | $0 | $10K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $3K | $0 | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 400 HIGHWAY 169 SOUTH, 8TH FLOOR SAINT LOUIS PARK, MN 55426 | USABLE LIFE | $7K | $0 | $7K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $2K | $0 | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 400 HIGHWAY 169 SOUTH 8TH FLOOR ST LOUIS PARK, MN 55426 | USABLE LIFE | $5K | $0 | $5K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $3K | $0 | $3K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203491 DALLAS, TX 75320 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $6K | $0 | $6K | 29.46% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 203373 DALLAS, TX 75320 | THE HARTFORD | $260 | $21 | $281 | 16.20% |
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 | 266 | 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) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 497 | $2.3M |
| Dental | CIGNA HEALTH AND LIFE INSURNACE COMPANY AND AFFILIATES | 233 | $210K |
| Vision | COMMUNITY EYE CARE | 252 | $41K |
| Life insurance(2 contracts) | USABLE LIFE | 265 | $74K |
| Long-term disability | USABLE LIFE | 266 | $67K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 497 | $2.3M |
| Other(5 contracts, 5 carriers) | USABLE LIFE | 286 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 497 | — |
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.