| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP, LLC | 18700 N HAYDEN ROAD SUITE 405 SCOTTSDALE, AZ 85255 | HCC LIFE INSURANCE COMPANY | $0 | $19K | $19K | 5.71% |
| JUSTICE-CREWS INSURANCE AGENCY INC.3 Filed as: JUSTICE-CREWS INS AGENCY INC | PO BOX 819 CHERRYVILLE, NC 28021 | HARTFORD LIFE AND ACCIDENT | $18K | $0 | $18K | 14.56% |
| BEVERLY J HOLLOWAY3 | 4042 BUCK HOLLOW LANE BLUFFDALE, UT 84065 | HARTFORD LIFE AND ACCIDENT | $0 | $7K | $7K | 5.37% |
| JUSTICE-CREWS INSURANCE AGENCY INC.3 Filed as: JUSTICE-CREWS INS AGENCY INC | PO BOX 819 CHERRYVILLE, NC 28021 | DELTA DENTAL OF NORTH CAROLINA | $6K | $0 | $6K | 11.65% |
| JUSTICE-CREWS INSURANCE AGENCY INC.3 Filed as: JUSTICE-CREWS INS AGENCY INC | PO BOX 819 CHERRYVILLE, NC 28021 | MANHATTANLIFE ASSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 21.71% |
| LOUIS BARBER3 | 8592 CORDES CIRCLE GERMANTOWN, TN 38139 | MANHATTANLIFE ASSURANCE COMPANY OF AMERICA | $418 | $0 | $418 | 3.21% |
| ALLAN BOYD3 | PO BOX 99062 RALEIGH, NC 27624 | MANHATTANLIFE ASSURANCE COMPANY OF AMERICA | $62 | $0 | $62 | 0.48% |
| JUSTICE-CREWS INSURANCE AGENCY INC.3 Filed as: JUSTICE-CREWS INS AGENCY INC | PO BOX 819 CHERRYVILLE, NC 28021 | DELTA DENTAL OF NORTH CAROLINA | $2K | $0 | $2K | 17.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MAIN STREET SWIMMER EIN 56-2185489 BROKER | Insurance agents and brokers Service code 22 | — | $51K |
| HEALTHGRAM INC EIN 56-1449504 N/A | Claims processing Service code 12 | — | $46K |
| CIGNA CORPORATION EIN 59-1031071 N/A | Claims processing Service code 12 | — | $22K |
| HEALTHGRAM- TELADOCINC EIN 47-4591265 N/A | Claims processing Service code 12 | — | $2K |
| CAREOPERATIVE LLC EIN 20-8981027 N/A | Claims processing Service code 12 | — | $2K |
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 | 164 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MANHATTANLIFE ASSURANCE COMPANY OF AMERICA | 31 | $13K |
| Dental | DELTA DENTAL OF NORTH CAROLINA | 147 | $49K |
| Vision | DELTA DENTAL OF NORTH CAROLINA | 146 | $11K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 164 | $124K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 164 | $124K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 164 | $124K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 120 | $326K |
| Other | HARTFORD LIFE AND ACCIDENT | 164 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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.