| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KENNETH W HARVEY3 | 717 WREN RD GASTONIA, NC 28056 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | — | $16K | 16.72% |
| CORPORATE BENEFITS SERVICE, INC.3 Filed as: CORPORATE BENEFITS SERVICE, INC | PO BOX 11937 CHARLOTTE, NC 28220 | UNITED HEALTHCARE INSURANCE COMPANY | $907 | — | $907 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORPORATE BENEFITS SERVICE, INC. EIN 56-1167792 NONE | Insurance agents and brokers Service code 22 | PO BOX 11937 CHARLOTTE, NC 28220 | $36K |
| CULPEPPER DEVEREAUX EIN 25-1912027 NONE | Insurance agents and brokers Service code 22 | 717 WREN ROAD GASTONIA, NC 28056 | $29K |
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 | 90 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 92 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 172 | $95K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 172 | $95K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 172 | $104K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 172 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.