| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $23K | — | $23K | 5.00% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $30K | — | $30K | 10.00% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $18K | — | $18K | 10.00% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | — | $14K | 10.00% |
| JUSTICE-CREWS INSURANCE AGENCY INC.3 Filed as: JUSTICE-CREWS INSURANCE AGENCY | PO BOX 819 CHERRYVILLE, NC 28021 | MANHATTEN LIFE INSURANCE AND ANNUITY COMPANY | $17K | — | $17K | 18.82% |
| ALLAN BOYD3 | PO BOX 99062 RALEIGH, NC 27624 | MANHATTEN LIFE INSURANCE AND ANNUITY COMPANY | $2K | — | $2K | 1.92% |
| LOUIS BARBER3 | 8588 CORDES CIRCLE GERMANTOWN, TN 38139 | MANHATTEN LIFE INSURANCE AND ANNUITY COMPANY | $1K | — | $1K | 1.55% |
| JAMES HARRIS3 | 1121 24TH AVE NE HICKORY, NC 28601 | MANHATTEN LIFE INSURANCE AND ANNUITY COMPANY | $504 | — | $504 | 0.56% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | — | $15K | 20.00% |
| JUSTICE-CREWS INSURANCE AGENCY INC.3 Filed as: JUSTICE-CREWS INS AGENCY | PO BOX 819 CHERRYVILLE, NC 280210819 | EMC NATIONAL LIFE COMPANY | $3K | — | $3K | 9.40% |
| ALLAN C BOYD JR.3 | 3915 W DOLPHIN DR. OAK ISLAND, NC 28465 | EMC NATIONAL LIFE COMPANY | $267 | — | $267 | 0.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THP INSURANCE COMPANY EIN 55-0765726 ADMINISTRATOR | Contract Administrator Service code 13 | — | $157K |
| TELADOC EIN 04-3705970 ADMINISTRATOR | Contract Administrator Service code 13 | — | $19K |
| CIGNA CORPORATION EIN 59-1031071 PPO ACCESS | Other services Service code 49 | — | $6K |
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 | 877 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 18 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 896 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MANHATTEN LIFE INSURANCE AND ANNUITY COMPANY | 188 | $90K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 731 | $457K |
| Vision | COMMUNITY EYE CARE | 982 | $88K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 960 | $475K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 445 | $178K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 960 | $518K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 982 | — |
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.