| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 4064 COLONY ROAD, SUITE 450 CHARLOTTE, NC 28211 | BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA | $42K | $0 | $42K | 4.37% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 2807 CLINTON, IA 52733 | AMERITAS LIFE INSURANCE CORPORATION | $14K | $0 | $14K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 21ST FLOOR ROLLING MEADOWS, IL 60008 | AMERITAS LIFE INSURANCE CORPORATION | $0 | $607 | $607 | 0.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 16.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.33% |
| DERRELL B ODOM3 Filed as: DERRELL ODOM | 5082 MARIANA COURT TEGA CAY, SC 29708 | AFLAC | $1K | $16 | $1K | 5.23% |
| DONNA L MATTHEWS3 Filed as: DONNA MATTHEWS | 4089 LINDA DRIVE ROCK HILL, SC 29730 | AFLAC | $638 | $16 | $654 | 2.63% |
| MJ INSURANCE3 Filed as: JEREMY CASSIDY AND VARIOUS AGENTS | 1833 HOPEWELL ROAD ROCK HILL, SC 29730 | AFLAC | $353 | $0 | $353 | 1.42% |
| DONALD E. ROLLACK3 Filed as: DONALD ROLLACK | PO BOX 962 FORT MILL, SC 29716 | AFLAC | $228 | $8 | $236 | 0.95% |
| CATHERINE D JAMES3 Filed as: CATHERINE JAMES | 4531 MEADOWOOD ROAD COLUMBIA, SC 29206 | AFLAC | $133 | $8 | $141 | 0.57% |
| DAVID C BERRY3 Filed as: DAVID BERRY | 2545 HEATHWAY DRIVE FLORENCE, SC 29501 | AFLAC | $53 | $0 | $53 | 0.21% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE LUCZAJ | 29 CRESTVIEW DRIVE RANCHO SANTA MARGARITA, CA 92688 | AFLAC | $50 | $0 | $50 | 0.20% |
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 | 138 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA | 117 | $951K |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 279 | $94K |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 279 | $94K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $65K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $40K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA | 117 | $951K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 279 | — |
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.