| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS FLACK3 | 123 E MAIN STREET FOREST CITY, NC 28043 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $15K | $0 | $15K | 6.68% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET FINANCIAL GROUP LLC | 22 N TRADE ST TRYON, NC 28782 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| UNITED PRODUCERS GROUP LLC3 | 1439 STUART ENGALS BLVD UNIT 300 MT PLEASANT, SC 29464 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
| BETTER CHOICE HEALTH LLC3 | 4461 NE 30TH AVE LIGHTHOUSE POINT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $409 | $0 | $409 | 2.59% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET FINANCIAL GROUP INC | 123 EAST MAIN STREET FOREST CITY, NC 28043 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $289 | $0 | $289 | 1.83% |
| CAROLINA BENEFITS SOURCE INC3 | 4461 NE 30TH AVE LIGHTHOUSE POINT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $268 | $0 | $268 | 1.69% |
| MELISSA SWARD3 | 4461 NE 30TH AVE LIGHTHOUSE POINT, FL 33064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $262 | $0 | $262 | 1.66% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES SE INC | 1901 ROXBOROUGH ROAD CHARLOTTE, NC 28211 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $244 | $0 | $244 | 1.54% |
| CREATIVE BENEFIT CONSULTANTS INC3 | 18214 102ND WAY S SUITE 100 BOCA RATON, FL 33498 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | $103 | $190 | 1.20% |
| SHELLEY HARTSELL3 Filed as: SHELLEY CAMPBELL HARTSELL | 21317 COUNTRY CLUB DRIVE CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $124 | $25 | $149 | 0.94% |
| MARK BRANNON SWARD3 | 8230 CARTER CREEK DR APT 207 CHARLOTTE, NC 28227 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $97 | $0 | $97 | 0.61% |
| DAVID MASON DOKELL3 | 159 BEACON STREET UNIT A MOORESVILLE, NC 28117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | $0 | $68 | 0.43% |
| LAURIE J BURNS3 Filed as: LAURIE JANE BURNS | 1274 BICYCLE CT YORK, SC 29745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $0 | $25 | 0.16% |
| SHAWNEENA MERCADO OVERLY3 | 3958 PARKERS FRY FORT MILL, SC 29715 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $0 | $16 | 0.10% |
| LYNN MARIE BARRY3 | 301 W PARK AVE LANGHOME, PA 19047 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.09% |
| ELITE ADMINISTRATION3 | 313 HARKINS BLUFF DR GREER, SC 29651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.08% |
| INSYNC BENEFITS INC3 | PO BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $1 | $10 | 0.06% |
| PETER MICHAEL FOLEY JR3 | 119 BRADLEY STREET PORTLAND, ME 04102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $0 | $8 | 0.05% |
| FOUNDERS FINANCIAL GROUP LLC3 | 737 PLANTATION ROAD LANCASTER, SC 29720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.01% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET FINANCIAL GROUP LLC | 22 N TRADE ST TRYON, NC 28782 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $776 | $0 | $776 | 10.00% |
| UNITED PRODUCERS GROUP LLC3 | 1439 STUART ENGALS BLVD UNIT 300 MT PLEASANT, SC 29464 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $388 | $388 | 5.00% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET FINANCIAL GROUP LLC | 22 N TRADE ST TRYON, NC 28782 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $671 | $0 | $671 | 10.00% |
| UNITED PRODUCERS GROUP LLC3 | 1439 STUART ENGALS BLVD UNIT 300 MT PLEASANT, SC 29464 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $336 | $336 | 5.01% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET FINANCIAL GROUP LLC | 22 N TRADE ST TRYON, NC 28782 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $430 | $0 | $430 | 10.00% |
| UNITED PRODUCERS GROUP LLC3 | 1439 STUART ENGALS BLVD UNIT 300 MT PLEASANT, SC 29464 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $215 | $215 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 MEDICAL CARRIER | Claims processing Service code 12 | — | $9K |
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 | 50 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 50 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 44 | $28K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 45 | $4K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 50 | $7K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 50 | $8K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 43 | $227K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 50 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 50 | — |
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.