Form 5500 · Employee benefit plan · BURLINGTON, NC
NORTH STATE DENTAL PARTNERS, INC.
The filing calls this plan THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P.
NORTH STATE DENTAL PARTNERS, INC. of BURLINGTON, NC spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is WENDY B PACE. Coverage is written through BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA and 2 other carriers. The plan's most recent policy period ended in November.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 26-3879799 · plan 501 · plan year 2025, filed Jun 26, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, vision, life and disability; the largest, with BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA, covers 138 people.
The filing declares health, vision, life, disability and dental. Dental appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $974,026, with $31,612 in disclosed broker commissions — about 3.2% of premium.
The health contract's policy period ended in November, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
WENDY B PACE is the broker of record on 1 of the 5 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | Health | 138 | Dec 1, 2025 | $887,091 | $19,408 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 47 | Dec 2, 2025 | $46,437 | $6,966 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 58 | Dec 2, 2025 | $19,627 | $2,944 |
| COMMUNITY EYE CARE | Vision | 135 | Dec 1, 2025 | $16,358 | $1,617 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 140 | Dec 2, 2025 | $4,513 | $677 |
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.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
How this plan compares
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