| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | P O BOX 9845 GREENSBORO, NC 27429 | BLUECROSS BLUESHIELD OF NORTH CAROLINA | $19K | — | $19K | 8.89% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | PO BOX 9845 GREENSBORO, NC 27429 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $634 | $9K | 16.17% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | PO BOX 9845 GREENSBORO, NC 27429 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $593 | $8K | 16.16% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | PO BOX 9845 GREENSBORO, NC 27429 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $185 | $3K | 16.07% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | PO BOX 9845 GREENSBORO, NC 27429 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $168 | $2K | 16.19% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | P O BOX 9845 GREENSBORO, NC 27429 | USABLE LIFE | $598 | — | $598 | 15.01% |
| MOSAIC GROUP SERVICES3 | 4605 UNIVERSITY DRIVE DURHAM, NC 27707 | USABLE LIFE | $199 | — | $199 | 4.99% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | P O BOX 9845 GREENSBORO, NC 27429 | USABLE LIFE | $416 | — | $416 | 15.00% |
| MOSAIC GROUP SERVICES3 | 4605 UNIVERSITY DRIVE DURHAM, NC 27707 | USABLE LIFE | $277 | — | $277 | 9.99% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | PO BOX 9845 GREENSBORO, NC 27429 | USABLE LIFE | $360 | — | $360 | 14.98% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $120 | — | $120 | 4.99% |
| WILLIFORD INSURANCE GROUP INC.3 Filed as: WILLIFORD INS GROUP | P O BOX 9845 GREENSBORO, NC 27429 | USABLE LIFE | $274 | — | $274 | 15.01% |
| MOSAIC GROUP SERVICES3 | P O BOX 11229 COLUMBIA, SC 29211 | USABLE LIFE | $73 | — | $73 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 | Insurance services Service code 23 | PO BOX 2291 DURHAM, NC 27702 | $99K |
| WILLIFORD INSURANCE GROUP EIN 56-1708341 | Insurance brokerage commissions and fees Service code 53 | PO BOX 27429 GREENSBORO, NC 27429 | $41K |
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 | 181 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | BLUECROSS BLUESHIELD OF NORTH CAROLINA | 181 | $217K |
| Life insurance(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 357 | $74K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 162 | $51K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $19K |
| Stop-loss / reinsurancereinsurance | BLUECROSS BLUESHIELD OF NORTH CAROLINA | 181 | $217K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 357 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 357 | — |
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.