| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DALE K. MOORE3 | PO BOX 220748 CHARLOTTE, NC 28210 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $36K | $2K | $38K | 3.29% |
| USI INSURANCE SERVICES LLC3 | 400 HIGHWAY 169 SOUTH, 8TH FLOOR SAINT LOUIS PARK, MN 55426 | USABLE LIFE | $10K | $42 | $10K | 11.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $5K | $0 | $5K | 5.96% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203508 DALLAS, TX 75320 | HUMANADENTAL INSURANCE COMPANY | $7K | $0 | $7K | 10.00% |
| IBSI HOLDINGS INC3 | PO BOX 24337 WINSTON SALEM, NC 27114 | HUMANADENTAL INSURANCE COMPANY | $4K | $0 | $4K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203508 DALLAS, TX 75320 | HUMANA INSURANCE COMPANY | $260 | $0 | $260 | 10.01% |
| IBSI HOLDINGS INC3 | PO BOX 24337 WINSTON SALEM, NC 27114 | HUMANA INSURANCE COMPANY | $130 | $0 | $130 | 5.01% |
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 | 167 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 219 | $1.2M |
| Dental | HUMANADENTAL INSURANCE COMPANY | 126 | $74K |
| Vision | HUMANA INSURANCE COMPANY | 60 | $3K |
| Life insurance | USABLE LIFE | 162 | $92K |
| Short-term disability | USABLE LIFE | 162 | $92K |
| Long-term disability | USABLE LIFE | 162 | $92K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 219 | $1.2M |
| Other | USABLE LIFE | 162 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 219 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.