| 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 | $31K | — | $31K | 5.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | PO BOX 23510 DALLAS, TX 75320 | HUMANA DENTAL INSURANCE COMPANY | $7K | $778 | $8K | 11.14% |
| IBSI HOLDINGS INC3 | PO BOX 24337 WINSTON SALEM, NC 27114 | HUMANA DENTAL INSURANCE COMPANY | $3K | — | $3K | 5.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICE INC | 400 HWY 169 2 ST LOUIS PARK, MN 55426 | USABLE LIFE | $6K | — | $6K | 11.11% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $4K | — | $4K | 6.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | PO BOX 203491 DALLAS, TX 75320 | ALLSTATE | $7K | — | $7K | 64.98% |
| JENNY AYERS3 | 4120 COUNTRYDOWN DR GREENVILLE, NC 27834 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $2K | — | $2K | 22.46% |
| J. ANDREWS INC.3 | 705 S. BROAD ST ROBERSONVILLE, NC 27871 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $175 | — | $175 | 1.99% |
| LORI SUMEREL3 | 4722 ALEXANDER VALLEY DR APT 101 CHARLOTTE, NC 28270 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $100 | — | $100 | 1.14% |
| DALE K. MOORE3 Filed as: DALE K MOORE | PO BOX 220748 CHARLOTTE, NC 28222 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $855 | — | $855 | 11.50% |
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 | 165 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 170 | $603K |
| Dental | HUMANA DENTAL INSURANCE COMPANY | 147 | $68K |
| Vision | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 89 | $7K |
| Life insurance | USABLE LIFE | 188 | $58K |
| Short-term disability | USABLE LIFE | 188 | $58K |
| Long-term disability | USABLE LIFE | 188 | $58K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 170 | $596K |
| Other(3 contracts, 3 carriers) | USABLE LIFE | 188 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 188 | — |
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.
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.