| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ERIC W. BLACK3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $84K | $532 | $84K | 4.86% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | HARTFORD LIFE AND ACCIDENT | $22K | $0 | $22K | 13.92% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES, LLC | 4611 UNIVERSITY DRIVE DURHAM, NC 27702 | HARTFORD LIFE AND ACCIDENT | $0 | $11K | $11K | 6.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | HARTFORD LIFE AND ACCIDENT | $0 | $899 | $899 | 0.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4250 CONGRESS STREET, SUITE 200 CHARLOTTE, NC 28209 | AMERITAS LIFE INSURANCE CORPORATION | $11K | $0 | $11K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 21ST FLOOR ROLLING MEADOWS, IL 60008 | AMERITAS LIFE INSURANCE CORPORATION | $0 | $1K | $1K | 1.32% |
| IBENEFIT COMMUNICATION LLC3 Filed as: IBENEFIT COMMUNICATION | 131 HILLSIDE AVENUE CHARLOTTE, NC 28209 | UNUM INSURANCE COMPANY | $3K | $387 | $3K | 12.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM INSURANCE COMPANY | $1K | $0 | $1K | 4.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM INSURANCE COMPANY | $0 | $207 | $207 | 0.75% |
| IBENEFIT COMMUNICATION LLC3 Filed as: IBENEFIT COMMUNICATION | 131 HILLSIDE AVENUE CHARLOTTE, NC 28209 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $621 | $7K | 42.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 16.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $264 | $264 | 1.65% |
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 | 269 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 26 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 295 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 292 | $1.7M |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 481 | $105K |
| Vision | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 292 | $1.7M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 273 | $157K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 273 | $157K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 273 | $157K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 292 | $1.7M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 273 | $201K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 481 | — |
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.