| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 4100 NEWPORT PLACE DRIVE #650 NEWPORT BEACH, CA 92660 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $16K | — | $16K | 4.80% |
| ANDREW L MOORE3 Filed as: ANDREW R. TORELLI | 4100 NEWPORT PLACE DRIVE SUITE 650 NEWPORT BEACH, CA 92660 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $9K | $3K | $12K | 3.67% |
| BENEFIT ADVISORS SERVICES GROUP LLC3 | 1125 SANCTUARY PARKWAY, #300 ALPHARETTA, GA 30009 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 0.32% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A. SCOTT & SON, INC. | 1301 OLD GRAVES MILL RD LYNCHBURG, VA 24502 | DELTA DENTAL OF NORTH CAROLINA | $0 | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD NC EIN 56-0894904 | Claims processing; Insurance agents and brokers Service code 12 | — | $239K |
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 | 553 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 553 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NORTH CAROLINA | 916 | $233K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 553 | $327K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 553 | $327K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 553 | $327K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 553 | $327K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 916 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.