| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PELNIK INSURANCE OF CARY NC, INC.3 Filed as: PELNIK INSURANCE OF CARY NC INC | 100 RIDGEVIEW DR. CARY, NC 27511 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $34K | $1K | $35K | 3.65% |
| PELNIK INSURANCE OF CARY NC, INC.3 Filed as: PELNIK INSURANCE OF CARY NC INC | 100 RIDGEVIEW DR. CARY, NC 27511 | METROPOLITAN LIFE INSURANCE COMPANY | $10K | — | $10K | 9.80% |
| PELNIK INSURANCE OF CARY NC, INC.3 Filed as: PELNIK INSURANCE OF CARY NC INC | 100 RIDGEVIEW DR. STE 100 CARY, NC 27511 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $2K | — | $2K | 9.21% |
| PELNIK INSURANCE OF CARY NC, INC.3 Filed as: PELNIK INSURANCE OF CARY NC INC | 100 RIDGEVIEW DR CARY, NC 27511 | USABLE LIFE | $2K | — | $2K | 9.87% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $1K | — | $1K | 6.66% |
| PELNIK INSURANCE OF CARY NC, INC.3 Filed as: PELNIK INSURANCE OF CARY NC INC. | 100 RIDGEVIEW DR. CARY, NC 27511 | USABLE LIFE | $2K | — | $2K | 15.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $1K | — | $1K | 10.00% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27511 | USABLE LIFE | $1K | — | $1K | 10.00% |
| PELNIK INSURANCE OF CARY NC, INC.3 Filed as: PELNIK INSURANCE OF CARY NC INC | 100 RIDGEVIEW DR CARY, NC 27511 | USABLE LIFE | $274 | — | $274 | 1.89% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: PELNIK INSURANC EOF CARY NC INC. | 100 RIDGEVIEW DR. CARY, NC 27511 | USABLE LIFE | $496 | — | $496 | 9.87% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $335 | — | $335 | 6.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 NONE | Claims processing; Contract Administrator; Participant communication 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 | 157 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 157 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 142 | $956K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 126 | $101K |
| Vision | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 105 | $21K |
| Life insurance(2 contracts) | USABLE LIFE | 110 | $29K |
| Long-term disability | USABLE LIFE | 156 | $15K |
| Other | USABLE LIFE | 157 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.