| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET INSURANCE GROUP | 22 N TRADE STREET TRYON, NC 28782 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $0 | $7K | 10.62% |
| UNITED PRODUCERS GROUP LLC3 | 1439 STUART ENGALS BLVD SUITE 300 MOUNT PLEASANT, SC 29464 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 4.07% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET FINANCIAL GROUP INC | 123 E MAIN STREET FOREST CITY, NC 28043 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $193 | $0 | $193 | 4.25% |
| JOANNE K ROY3 | 5500 TURKEY OAK DR MINT HILL, NC 28227 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $101 | $31 | $132 | 2.90% |
| LINDA P COLEMAN3 | 18908 RIVERMIND LANE DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $0 | $58 | 1.28% |
| FRANCES LYNN MCCARTER3 | 10331 LINKSLAND DR HUNTERSVILLE, NC 28078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $0 | $58 | 1.28% |
| TONI E STEED LLC3 | 11218 WARFIELD AVE HUNTERSVILLE, NC 28078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | $0 | $43 | 0.95% |
| DONNA N DWYER3 | 1495 RYMCO DR SUITE 108 WINSTON SALEM, NC 27103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | $3 | $34 | 0.75% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: UNHUI KIM BROWN | PO BOX 1722 DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.48% |
| FOUNDERS FINANCIAL GROUP LLC3 | 737 PLANTATION ROAD LANCASTER, SC 29720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $5 | $15 | 0.33% |
| PHIL COLEMAN3 | 18908 RIVERMIND LANE DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.22% |
| ADVANCED BENEFIT SYSTEM INC3 | 145 RIVER LANDING DRIVE DANIEL ISLAND, SC 29492 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $5 | $8 | 0.18% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET FINANCIAL GROUP INC | 123 E MAIN STREET FOREST CITY, NC 28043 | THE PAUL REVERE LIFE INSURANCE COMPANY | $184 | $0 | $184 | 6.19% |
| SHAWNEENA MERCADO OVERLY3 | 3958 PARKERS FRY FORT MILL, SC 29715 | THE PAUL REVERE LIFE INSURANCE COMPANY | $142 | $16 | $158 | 5.32% |
| HOWARD HOROWITZ3 Filed as: HOWARD J HOROWITZ | 2610 ALCOTT ST CARMEL, UT 46032 | THE PAUL REVERE LIFE INSURANCE COMPANY | $59 | $9 | $68 | 2.29% |
| JOANNE K ROY3 | 5500 TURKEY OAK DR MINT HILL, NC 28227 | THE PAUL REVERE LIFE INSURANCE COMPANY | $61 | $0 | $61 | 2.05% |
| DONNA N DWYER3 | 1495 RYMCO DR SUITE 108 WINSTON SALEM, NC 27103 | THE PAUL REVERE LIFE INSURANCE COMPANY | $30 | $0 | $30 | 1.01% |
| FOUNDERS FINANCIAL GROUP LLC3 | 737 PLANTATION ROAD LANCASTER, SC 29720 | THE PAUL REVERE LIFE INSURANCE COMPANY | $18 | $6 | $24 | 0.81% |
| 3C HOLDINGS INC3 | 4219 ALDERSHOT CT CHARLOTTE, NC 28211 | THE PAUL REVERE LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.34% |
| ADVANCED BENEFIT SYSTEM INC3 | 145 RIVER LANDING DR DANIEL ISLAND, SC 29492 | THE PAUL REVERE LIFE INSURANCE COMPANY | $9 | $0 | $9 | 0.30% |
| PHIL COLEMAN3 | 18908 RIVER WIND LANE DAVIDSON, NC 28036 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8 | $0 | $8 | 0.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES EIN 41-1289245 CLAIMS | Claims processing Service code 12 | — | $21K |
| THOMAS FLACK BROKER | Insurance agents and brokers Service code 22 | 307 GREEN MEADOWS DRIVE FOREST CITY, NC 28043 | $14K |
| MAIN STREET FINANCIAL GROUP INC BROKER | Insurance agents and brokers Service code 22 | 123 E MAIN STREET FOREST CITY, NC 28043 | $218 |
| UNITED PRODUCERS GROUP LLC N/A | Insurance agents and brokers Service code 22 | 1439 STUART ENGALS BLVD UNIT 300 MOUNT PLEASANT, SC 29464 | $28 |
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 | 51 | 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) | 51 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 94 | $63K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 94 | $63K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 94 | $63K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 94 | $63K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 94 | $63K |
| Stop-loss / reinsurancereinsurance | ALL SAVERS INSURANCE COMPANY | 39 | $148K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 3 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.