| 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 | $53K | — | $53K | 3.82% |
| SHANNON BUCKNER3 | 8049 CORPORATE CENTER DRIVE CHARLOTTE, NC 28226 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $476 | — | $476 | 0.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 203508 DALLAS, TX 75320 | HUMANA INSURANCE COMPANY | $688 | — | $688 | 0.58% |
| IBSI HOLDINGS INC3 | PO BOX 24337 WINSTON SALEM, NC 27114 | HUMANA INSURANCE COMPANY | $430 | — | $430 | 0.36% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $5K | — | $5K | 10.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $2K | — | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $3K | — | $3K | 10.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $2K | — | $2K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $4K | $180 | $4K | 15.77% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SVCS LLC | 4840 COX ROAD SUITE 150 GLEN ALLEN, VA 23060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 17.39% |
| JENNY AYERS3 | 522 BUTLER DRIVE HENRICO, NC 27842 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $2K | — | $2K | 14.64% |
| JOHN HALL3 | 6809 TREE HILL ROAD MATTHEWS, NC 28104 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $345 | — | $345 | 2.92% |
| JENNA DOYLE3 | 3665 HIGHLAND DRIVE AYDEN, NC 28513 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $157 | — | $157 | 1.33% |
| SHEILA W JOHNSON3 | 135 CHURCHILL ROAD HOOKERTON, NC 28538 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $57 | — | $57 | 0.48% |
| JEANETTE ANDREWS3 | 705 SOUTH BROAD STREET ROBERSONVILLE, NC 27871 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $25 | — | $25 | 0.21% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $677 | — | $677 | 9.99% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $339 | — | $339 | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $628 | $61 | $689 | 16.46% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $418 | — | $418 | 9.99% |
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 | 194 | 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) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 196 | $1.4M |
| Dental | HUMANA INSURANCE COMPANY | 165 | $118K |
| Vision | HUMANA INSURANCE COMPANY | 165 | $118K |
| Life insurance(2 contracts) | USABLE LIFE | 232 | $30K |
| Short-term disability | USABLE LIFE | 232 | $33K |
| Long-term disability | USABLE LIFE | 232 | $46K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 196 | $1.4M |
| Other(5 contracts, 3 carriers) | USABLE LIFE | 232 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 232 | — |
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."
No prospect flags tripped on this filing.