| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES RUSSELL BEAM3 | 802 HAWTHORNE STREET CHEERYVILLE, NC 28021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $0 | $6K | 8.11% |
| MAIDEN BENEFITS GROUP INC3 | 511 ISLAND FORD RD MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $241 | $5K | 7.42% |
| KENNA S GEORGE3 | 6367 STARTOWN ROAD MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $59 | $1K | 1.88% |
| JEFFREY BRANDON MCREE3 | 17133 DOE VALLEY COURT CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $87 | $1K | 1.62% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: JONI BROWN | 403 N 1ST AVE MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.54% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BRIAN T BROWN | 403 N 1ST AVE MAIDEN, NC 28650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $770 | $0 | $770 | 1.10% |
| JUAN CARLOS SUAREZ3 | 5415 BRIDGEGATE DRIVE WINSTON SALEM, NC 27106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $136 | $0 | $136 | 0.19% |
| ASSUREDPARTNERS3 Filed as: SYDNEY MICHELLE SHEPHERD | 6874 LOCKE DRIVE SHERRILLS FORD, NC 28673 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | $0 | $50 | 0.07% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 10.00% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $0 | $11K | 20.00% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 20.00% |
| WATSON INSURANCE AGENCY INC3 | P.O. BOX 879 GASTONIA, NC 28053 | PRINCIPAL LIFE INSURANCE COMPANY | $24K | $0 | $24K | 83.96% |
| WATSON INSURANCE AGENCY INC3 | 245 E SECOND AVE GASTONIA, NC 28052 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 15.00% |
| 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 | $542 | $0 | $542 | 15.00% |
| 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 | $366K |
| CORPORATE BENEFITS SERVICE EIN 56-1167792 BENEFIT ADMIN | Claims processing; Plan Administrator Service code 12 | P.O. BOX 11937 CHARLOTTE, NC 28220 | $72K |
| WATSON INS AGENCY EIN 56-0445105 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 745 E. SECOND AVE GASTONIA, NC 28052 | $55K |
| CIGNA EIN 59-1031071 TELEDOC/REPRICING FEES | Claims processing Service code 12 | — | $18K |
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 | 163 | 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) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 242 | $83K |
| Vision(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 242 | $40K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 242 | $36K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 242 | $62K |
| Long-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 242 | $32K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 163 | $132K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.