| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA | HEARST TOWER 214 N TRYON ST CHARLOTTE, NC 28282 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 0.73% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA | HEARST TOWER 214 N TRYON ST CHARLOTTE, NC 28282 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $5K | $5K | 0.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | 214 N TRYON ST SUITE 2500 CHARLOTTE, NC 282022381 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 0.58% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS-LIST ATTACHED | — | AFLAC | $69K | $4K | $73K | 23.54% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS-ATTACHED LIST | PO BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $27K | $876 | $28K | 14.92% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA | HEARST TOWER 214 N TRYON ST CHARLOTTE, NC 28282 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $363 | $363 | 0.73% |
| JOHN JOSEPH RODRIGUEZ4 | PO BOX 136 ENKA, NC 28728 | PREPAID LEGAL SERVICE DBA LEGALSHIELD | $3K | — | $3K | 9.29% |
| WILLIAM R. GUYTHER4 | 1005 ROGOSIN BLVD LOWELL, NC 28098 | PREPAID LEGAL SERVICE DBA LEGALSHIELD | $1K | — | $1K | 3.56% |
| JESSIC L HERNANDEZ4 | 55 ROCK HILL CIRCLE ASHEVILLE, SC 28803 | PREPAID LEGAL SERVICE DBA LEGALSHIELD | $119 | — | $119 | 0.37% |
| JOHN J DADAK III4 | 17 BLACK WALNUT LN CANDLER, NC 28715 | PREPAID LEGAL SERVICE DBA LEGALSHIELD | $27 | — | $27 | 0.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 MED CLAIMS ADMINISTRATOR | Insurance agents and brokers Service code 22 | — | $1.5M |
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 | 2,844 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,858 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 2,293 | $278K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,778 | $1.1M |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,778 | $931K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,778 | $435K |
| Other(5 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,778 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,778 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.