| 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 | $46K | — | $46K | 3.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 203508 DALLAS, TX 75320 | HUMANA INSURANCE COMPANY | $11K | — | $11K | 11.14% |
| IBSI HOLDINGS INC3 | PO BOX 24337 WINSTON SALEM, NC 27114 | HUMANA INSURANCE COMPANY | $5K | — | $5K | 4.95% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 400 HIGHWAY 169 SOUTH 8TH FLOOR ST LOUIS PARK, MN 55426 | USABLE LIFE | $4K | $723 | $4K | 11.98% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $2K | — | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 400 HIGHWAY 169 SOUTH 8TH FLOOR ST LOUIS PARK, MN 55426 | USABLE LIFE | $3K | $549 | $3K | 12.05% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $1K | — | $1K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 400 HIGHWAY 169 SOUTH 8TH FLOOR ST LOUIS PARK, MN 55426 | USABLE LIFE | $3K | $408 | $4K | 16.77% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 203491 DALLAS, TX 75320 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 16.59% |
| JENNY AYERS3 | 522 BUTLER DRIVE HENRICO, NC 27842 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $2K | — | $2K | 20.11% |
| JENNA DOYLE3 | 3665 HIGHLAND DRIVE AYDEN, NC 28513 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $158 | — | $158 | 1.90% |
| SHEILA W JOHNSON3 | 135 CHURCHILL ROAD HOOKERTON, NC 28538 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $45 | — | $45 | 0.54% |
| JEANETTE ANDREWS3 | 705 SOUTH BROAD STREET ROBERSONVILLE, NC 27871 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $21 | — | $21 | 0.25% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 400 HIGHWAY 169 SOUTH 8TH FLOOR ST LOUIS PARK, MN 55426 | USABLE LIFE | $572 | $121 | $693 | 12.12% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $286 | — | $286 | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 400 HIGHWAY 169 SOUTH 8TH FLOOR ST LOUIS PARK, MN 55426 | USABLE LIFE | $582 | $62 | $644 | 16.61% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $388 | — | $388 | 10.01% |
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 | 159 | 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) | 161 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 163 | $1.2M |
| Dental | HUMANA INSURANCE COMPANY | 143 | $103K |
| Vision | HUMANA INSURANCE COMPANY | 143 | $103K |
| Life insurance(2 contracts) | USABLE LIFE | 192 | $29K |
| Short-term disability | USABLE LIFE | 192 | $27K |
| Long-term disability | USABLE LIFE | 192 | $36K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 163 | $1.2M |
| Other(5 contracts, 3 carriers) | USABLE LIFE | 192 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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.