| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $22K | — | $22K | 8.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $5K | $13K | 5.09% |
| D.L. DAVIS & COMPANY INC.3 Filed as: D. L. DAVIS AND COMPANY, INC. | UNKNOWN SUITE 250 WINSTON SALEM, NC 27101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | — | $7K | 8.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 6330 SOUTH 3000 EAST, SUITE 670 SALT LAKE CITY, UT 84121 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $2K | — | $2K | 9.23% |
| WILLIAM TAYLOR CAMPBELL III3 | 5080 NOTTINGHAM PLACE LANE WINSTON SALEM, NC 27106 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $7 | — | $7 | 0.03% |
| DERRICK LEE DAVIS3 | 1315 SOUTH MAIN STREET WINSTON SALEM, NC 27127 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $7 | — | $7 | 0.03% |
| NICHOLAS B. GAVALAS3 | 799 CREEKSIDE DRIVE MOUNT PLEASANT, SC 29464 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| J. SAM PLEXICO & ASSOCIATES3 Filed as: J. SAM PLEXICO AND ASSOCIATES, INC. | PO BOX 727 BARNWELL, SC 29812 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $109 | — | $109 | 1.95% |
| BENEFITS COUNT INC3 Filed as: BENEFITS COUNT I, INC. | 248 RIVERWOOD DRIVE LEWISVILLE, NC 27023 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $65 | — | $65 | 1.16% |
| D.L. DAVIS & COMPANY INC.3 Filed as: D.L. DAVIS AND COMPANY, INC. | 1111 SOUTH MARSHALL STREET WINSTON-SALEM, NC 27101 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.68% |
| JENNIFER ARRINGTON3 Filed as: JENNIFER ARRINGTON AND OTHER AGENTS | 107 BELLVIEW DRIVE TAYLORS, SC 29687 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $35 | $2 | $37 | 0.66% |
| ADVANCED BENEFIT SYSTEM INC3 Filed as: ADVANCED BENEFIT SYSTEM, INC. | 1301 GERVAIS STREET COLUMBUS, SC 29201 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.39% |
| RYLEE ENTERPRISES INC3 Filed as: RYLEE ENTERPRISES, INC. | 1828 OAK RIDGE ROAD OAK RIDGE, NC 27310 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.23% |
| ARTHUR WAYNE JORDAN JR3 Filed as: ARTHUR W. JORDAN, JR. | 514 OAKWOOD AVENUE RALEIGH, NC 27601 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $1 | $12 | 0.21% |
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 | 255 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 255 | $276K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 255 | $255K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 255 | $337K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.