| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES LLC | 4615 UNIVERSITY DRIVE DURHAM, NC 27707 | SYMETRA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.58% |
| JAMES A SCOTT & SON INC3 | 1301 OLD GRAVES MILL RD LYNCHBURG, VA 24502 | SYMETRA LIFE INSURANCE COMPANY | — | $821 | $821 | 2.10% |
| WATCHTOWER BENEFITS, LLC3 Filed as: WATCHTOWER BENEFITS LLC | 2734 N MILDRED AVE #3 CHICAGO, IL 60614 | SYMETRA LIFE INSURANCE COMPANY | — | $585 | $585 | 1.50% |
| IBENEFIT COMMUNICATION LLC3 Filed as: IBENEFIT COMMUNICATIONS LLC | 6230 FAIRVIEW RD #210 CHARLOTTE, NC 28210 | SYMETRA LIFE INSURANCE COMPANY | $13K | — | $13K | 42.29% |
| JAMES A SCOTT & SON INC3 | 1301 OLD GRAVES MILL RD LYNCHBURG, VA 24502 | SYMETRA LIFE INSURANCE COMPANY | $5K | $364 | $6K | 19.35% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP SERVICES LLC | 4615 UNIVERSITY DRIVE DURHAM, NC 27707 | SYMETRA LIFE INSURANCE COMPANY | — | $1K | $1K | 4.54% |
| THREEFLOW3 | 306 W ERIE ST, STE 300 CHICAGO, IL 60694 | EYEMED VISION CARE OBO THE FIDELITY SECURITY LIFE INSURANCE COMPANY | $181 | — | $181 | 1.15% |
| RUTH A ANDERSON4 | 331 S FAYETTEVILLE STREET CLAYTON, NC 27520 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 30.89% |
| JAMES A SCOTT & SON INC4 Filed as: JAMES A SCOTT AND SON INC | 1301 OLD GRAVES MILL RD LYNCHBURG, VA 24502 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $596 | — | $596 | 8.84% |
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 171 | $1.2M |
| Dental | DELTA DENTAL OF NORTH CAROLINA | 251 | $96K |
| Vision | EYEMED VISION CARE OBO THE FIDELITY SECURITY LIFE INSURANCE COMPANY | 226 | $16K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 121 | $39K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 121 | $39K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 121 | $39K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 171 | $1.2M |
| Other(3 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 193 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 251 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.