| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DALE K. MOORE3 Filed as: DALE K MOORE | P.O. BOX 220748 CHARLOTTE, NC 28222 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $61K | — | $61K | 1.96% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SVCS USA, INC | 6100 FAIRVIEW ROAD, SUITE 1400 P.O. BOX 220748 CHARLOTTE, NC 282220748 | AMERITAS LIFE INSURANCE CORP. | $25K | — | $25K | 8.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SVCS USA, INC | 5200 N PALM AVE SUITE 114 FRESNO, CA 937042225 | AMERITAS LIFE INSURANCE CORP. | — | $4K | $4K | 1.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA, INC. | P.O. BOX 203510 DALLAS, TX 753203510 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 11.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA, INC. | 5214 68TH ST LUBBOCK, TX 794241598 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 3.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA, INC. | P.O. BOX 203510 DALLAS, TX 753203510 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 11.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA, INC. | 5214 68TH ST LUBBOCK, TX 794241598 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 3.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA, INC. | P.O. BOX 203510 DALLAS, TX 753203510 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $10K | 17.90% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA, INC. | P.O. BOX 203510 DALLAS, TX 753203510 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 11.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SRVCS USA, INC. | 5214 68TH ST LUBBOCK, TX 794241598 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 3.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVC USA INC. | P.O. BOX 220748 CHARLOTTE, NC 28222 | USABLE LIFE | $10K | — | $10K | 25.11% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | P.O. BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $5K | — | $5K | 12.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | P.O. BOX 203491 DALLAS, TX 75320 | ALLSTATE INSURANCE COMPANY | $11K | — | $11K | 65.19% |
| AFFINITY, INC.3 | 6813 LINDA LAKE DR CHARLOTTE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $298 | — | $298 | 3.56% |
| CAROLINA BENEFITS SOURCE INC3 Filed as: CAROLINA BENEFITS SOURCE, INC. | 4461 NE 30TH AVE LIGHTHOUSE PT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $119 | — | $119 | 1.42% |
| FRANCES LYNN MCCARTER3 | 10331 LINKSLAND DRIVE HUNTERSVILLE, NC 28078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.56% |
| LINDA P COLEMAN3 Filed as: LINDA P. COLEMAN | 18908 RIVER WIND LANE DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.56% |
| TONI E STEED LLC3 | 11218 WARFIELD AVE HUNTERSVILLE, NC 28078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.53% |
| PHIL COLEMAN3 | 18908 RIVERWIND LN DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.18% |
| PETER MICHAEL FOLEY JR3 Filed as: PETER MICHAEL FOLEY JR. | 150 PAMPLICO LANE MOORESVILLE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.16% |
| INSYNC BENEFITS INC3 Filed as: INSYNC BENEFITS INC. | P.O. BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.08% |
| AFFINITI INC3 | 6813 LINDA LAKE DRIVE CHARLOTTE, NC 28215 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 1.48% |
| FRANCES LYNN MCCARTER3 | 10331 LINKSLAND DR HUNTERSVILLE, NC 28078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.84% |
| LINDA P COLEMAN3 Filed as: LINDA P. COLEMAN | 18908 RIVER WIND LANE DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.84% |
| CAROLINA BENEFITS SOURCE INC3 | 4461 NE 30TH AVE LIGHTHOUSE PT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.63% |
| TONI E STEED LLC3 Filed as: TONI E STEED, LLC | 11218 WARFIELD AVE. HUNTERSVILLE, NC 28078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.42% |
| PHIL COLEMAN3 | P.O. BOX 700 DAVIDSON, NC 28036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.21% |
| INSYNC BENEFITS INC3 Filed as: INSYNC BENEFITS, INC. | P.O. BOX474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 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 | 427 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 431 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 710 | $3.1M |
| Dental | AMERITAS LIFE INSURANCE CORP. | 851 | $317K |
| Vision | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 710 | $3.1M |
| Life insurance(5 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 407 | $172K |
| Short-term disability(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 370 | $63K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 370 | $68K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 710 | $3.1M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 407 | $163K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 851 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.