| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALPINE AGENCY, LLC3 | 8910 TWO NOTCH ROAD, SUITE 200 COLUMBIA, SC 29223 | BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA | $44K | — | $44K | 4.00% |
| MST INSURANCE SOLUTIONS, INC.3 | 21241 S. WESTERN AVE. STE 200 TORRANCE, CA 90501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $788 | $788 | 2.06% |
| MST INSURANCE SOLUTIONS, INC.3 | 21241 S. WESTERN AVE. STE 200 TORRANCE, CA 90501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| PAYCHEX INSURANCE AGENCY, INC.5 | 150 SAWGRASS DR ROCHESTER, NY 14620 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $696 | $696 | 2.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $643 | $643 | 1.89% |
| MST INSURANCE SOLUTIONS, INC.3 | 21241 S. WESTERN AVE. STE 200 TORRANCE, CA 90501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.89% |
| PAYCHEX INSURANCE AGENCY, INC.5 Filed as: PAYCHEX AGENCY, INC. | 150 SAWGRASS DR ROCHESTER, NY 14620 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $696 | $696 | 2.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $652 | $652 | 1.92% |
| MST INSURANCE SOLUTIONS, INC.3 | 21241 S. WESTERN AVE. STE 200 TORRANCE, CA 90501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 14.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $605 | $605 | 2.00% |
| MST INSURANCE SOLUTIONS, INC.3 | 21241 S. WESTERN AVE. STE 200 TORRANCE, CA 90501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $770 | — | $770 | 9.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $159 | $159 | 2.06% |
| PAYCHEX INSURANCE AGENCY, INC.5 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DR ROCHESTER, NY 14620 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $696 | $696 | 14.93% |
| MST INSURANCE SOLUTIONS, INC.3 | 21241 S. WESTERN AVE. STE 200 TORRANCE, CA 90501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $466 | — | $466 | 9.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $88 | $88 | 1.89% |
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 | 95 | 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) | 95 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA | 77 | $1.1M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 79 | $38K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 76 | $8K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $35K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $34K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $34K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA | 77 | $1.1M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 95 | — |
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.