| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT ANDERSON3 | 432 HIGHLAND FOREST DRIVE CHARLOTTE, NC 28270 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $9K | $0 | $9K | 0.90% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62819 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $4K | $14K | 14.48% |
| SHEALY BENEFITS SERVICES INC3 Filed as: SHEALY BENEFITS SERVICES, INC. | 201 CAUGHMAN FARM LANE LEXINGTON, SC 29072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 5.00% |
| SHEALY BENEFITS SERVICES INC5 Filed as: SHEALY BENEFITS SERVICES | 215 HOGAN WAY LEXINGTON, SC 29072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 2.73% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62819 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $19K | $322 | $19K | 21.84% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES, LLC | PO BOX 2291 DURHAM, NC 27702 | HARTFORD LIFE AND ACCIDENT | $0 | $6K | $6K | 7.00% |
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 | 129 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 144 | $995K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $97K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $97K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 129 | $89K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 129 | $89K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 129 | $89K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 144 | $995K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $186K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 144 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.