Form 5500 · Employee benefit plan · CHARLOTTE, NC
CHARLOTTE COUNTRY CLUB, INC.
CHARLOTTE COUNTRY CLUB, INC. of CHARLOTTE, NC files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is JAMES A SCOTT & SON INC. Coverage is written through BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA and 3 other carriers. The plan's most recent policy period ended in January.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 56-0173700 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 5 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA, covers 160 people.
Reported premium across the insured contracts is $909,644, with $16,889 in disclosed broker commissions — about 1.9% of premium.
The most recent policy period ended in January, and the plan year ends January 31. Group contracts typically renew on that annual cycle.
JAMES A SCOTT & SON INC is the broker of record on 3 of the 5 contracts; the rest name a different broker or none.
4 carriers appear on the filing — BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA, DELTA DENTAL OF NORTH CAROLINA, HARTFORD LIFE AND ACCIDENT and COMBINED STATES L.S., INC — with BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DELTA DENTAL OF NORTH CAROLINA | Dental | 171 | January | $85,293 | $7,623 |
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 161 | January | $74,027 | $7,403 |
| COMBINED STATES L.S., INC | — | 21 | January | $5,472 | $1,000 |
| DELTA DENTAL OF NORTH CAROLINA | Vision | 150 | January | $9,460 | $863 |
| BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | Health | 160 | January | $735,392 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
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