| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MAIDEN BENEFITS GROUP INC3 | 511 ISLAND FORD RD MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $268 | $4K | 5.56% |
| JAMES RUSSELL BEAM3 | 802 HAWTHORNE STREET CHEERYVILLE, NC 28021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 5.27% |
| KENNA S GEORGE3 | 6367 STARTOWN ROAD MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.30% |
| JEFFREY BRANDON MCREE3 | 17133 DOE VALLEY COURT CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $728 | $46 | $774 | 0.98% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: JONI BROWN | 403 N 1ST AVE MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $613 | $107 | $720 | 0.91% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BRIAN T BROWN | 403 N 1ST AVE MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $260 | $0 | $260 | 0.33% |
| JUAN CARLOS SUAREZ3 | 5415 BRIDGEGATE DRIVE WINSTON SALEM, NC 27106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | $0 | $46 | 0.06% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 10.00% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $0 | $12K | 20.00% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 20.00% |
| CHARLOTTE R SANTA CRUZ3 Filed as: CHARLOTTE HARVEY, WATSON INSURANCE | — | ROUTINE VISION | $1K | $0 | $1K | 10.00% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 20.00% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $650 | $0 | $650 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TPAC UNDERWRITERS INC EIN 75-2396335 BENEFIT ADMIN | Plan Administrator; Claims processing Service code 12 | 3810 PHEASANT RIDGE DRIVE NE SUITE 300 MINNEAPOLIS, MN 55449 | $426K |
| CORPORATE BENEFITS SERVICE EIN 56-1167792 BENEFIT ADMIN | Claims processing; Plan Administrator Service code 12 | P.O. BOX 11937 CHARLOTTE, NC 28220 | $63K |
| WATSON INS AGENCY EIN 56-0445105 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 745 E. SECOND AVE GASTONIA, NC 28052 | $48K |
| CIGNA EIN 59-1031071 TELEDOC/REPRICING FEES | Claims processing Service code 12 | — | $17K |
| CUPEPPER DEVEREAUX INC EIN 25-1912027 RX CONSULTING FEES | Claims processing Service code 12 | — | $7K |
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 | 142 | 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) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 110 | $68K |
| Vision(2 contracts, 2 carriers) | ROUTINE VISION | 163 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 142 | $8K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 85 | $36K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 10 | $4K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 142 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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.