| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DALE K. MOORE3 | PO BOX 220748 CHARLOTTE, NC 28222 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $53K | — | $53K | 3.65% |
| USI INSURANCE SERVICES LLC3 | 6100 FAIRVIEW ROAD SUITE 800 CHARLOTTE, NC 28210 | HUMANA INSURANCE COMPANY | $20K | $5K | $25K | 21.07% |
| IBSI HOLDINGS INC3 | PO BOX 24337 WINSTON SALEM, NC 27114 | HUMANA INSURANCE COMPANY | $5K | — | $5K | 4.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 203508 DALLAS, TX 75320 | HUMANA INSURANCE COMPANY | -$2K | — | -$2K | -1.74% |
| 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 | $3K | — | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $4K | — | $4K | 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 | $273 | $4K | 16.11% |
| 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 | $4K | — | $4K | 18.90% |
| OBAL BRIAN3 | 3190 FAIRVIEW PARK DRIVE SUITE 40 FALLS CHURCH, VA 22042 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | — | $64 | $64 | 0.34% |
| JENNY AYERS3 | 522 BUTLER DRIVE HENRICO, NC 27842 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $788 | — | $788 | 8.96% |
| JOHN HALL3 | 6809 TREE HILL ROAD MATTHEWS, NC 28104 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $287 | — | $287 | 3.26% |
| JENNA DOYLE3 | 3665 HIGHLAND DRIVE AYDEN, NC 28513 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $87 | — | $87 | 0.99% |
| JEANETTE ANDREWS3 | 705 SOUTH BROAD STREET ROBERSONVILLE, NC 27871 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $23 | — | $23 | 0.26% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $712 | — | $712 | 9.99% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $356 | — | $356 | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62689 VIRGINIA BEACH, VA 23466 | USABLE LIFE | $756 | $77 | $833 | 16.52% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $504 | — | $504 | 10.00% |
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 | 175 | 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) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 180 | $1.5M |
| Dental | HUMANA INSURANCE COMPANY | 144 | $120K |
| Vision | HUMANA INSURANCE COMPANY | 144 | $120K |
| Life insurance(2 contracts) | USABLE LIFE | 204 | $32K |
| Short-term disability | USABLE LIFE | 204 | $35K |
| Long-term disability | USABLE LIFE | 204 | $52K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 180 | $1.5M |
| Other(5 contracts, 3 carriers) | USABLE LIFE | 204 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.