| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOZINGO, JAMES R3 | 921 S MCPHERSON CHURCH RD FAYETTEVILLE, NC 28303 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $7K | — | $7K | 4.77% |
| EBENCONCEPTS COMPANY3 | 5050 SPRING VALLEY ROAD DALLAS, TX 85244 | USABLE LIFE | $703 | $183 | $886 | 10.23% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $433 | — | $433 | 5.00% |
| INDEPENDENT INSURANCE GROUP INC3 | 921 S MCPHERSON CHURCH RD FAYETTEVILLE, NC 28303 | USABLE LIFE | $163 | — | $163 | 1.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYERS DIRECT HEALTH, INC. EIN 75-2322062 CLAIMS ADMINISTRATION | Other fees; Contract Administrator; Claims processing Service code 12 | — | $77K |
| EBENCONCEPTS COMPANY, INC. EIN 75-2966596 BENEFITS CONSULTANT | Consulting fees; Consulting (general) Service code 16 | — | $18K |
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 | 247 | 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) | 247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 358 | $151K |
| Dental | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 358 | $151K |
| Life insurance | USABLE LIFE | 158 | $9K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 196 | $299K |
| Other | USABLE LIFE | 158 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 358 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.