| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LISA L. HAMLETT3 | 100 N. MAIN ST., MAIL CODE NC6952 WINSTON-SALEM, NC 27105 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $30K | — | $30K | 3.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS | 301 S COLLEGE STREET #19 CHARLOTTE, NC 28202 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $13K | — | $13K | 20.00% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SVC, LLC | PO BOX 2291 DURHAM, NC 27702 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $3K | — | $3K | 4.33% |
| WELLS FARGO INSURANCE SERVICES3 | PO BOX 203510 DALLAS, TX 753203510 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 10.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS | 301 S COLLEGE STREET #19 CHARLOTTE, NC 28202 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $2K | — | $2K | 14.38% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SVC, LLC | PO BOX 2291 DURHAM, NC 27702 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $217 | — | $217 | 1.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AMERITAS LIFE INSURANCE CORP. EIN 47-0098400 | Contract Administrator Service code 13 | PO BOX 81889 LINCOLN, NE 685011889 | $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 | 165 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 213 | $781K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 16 | $15K |
| Life insurance(2 contracts) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 333 | $77K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 273 | $64K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 213 | $781K |
| Other(2 contracts) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 333 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 333 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.