| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAWN HARTIS3 | PO BOX 577 SYLVA, NC 28779 | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | $15K | — | $15K | 9.21% |
| STANBERRY INSURANCE AGENCY INC3 | 715 E MAIN STREET SYLVA, NC 28779 | GUARDIAN | $2K | — | $2K | 5.37% |
| CONSOLIDATED PLANNING HOLDINGS3 | 4201 CONGRESS ST STE 295 CHARLOTTE, NC 28209 | GUARDIAN | $23 | — | $23 | 0.05% |
| STANBERRY INSURANCE AGENCY INC | PO BOX 577 SYLVA, NC 28779 | USABLE LIFE | $342 | — | $342 | 9.97% |
| MOSAIC GROUP SERVICES Filed as: MOSAIC GROUP | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $331 | — | $331 | 9.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 | Claims processing; Insurance agents and brokers Service code 12 | — | $15K |
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 | 142 | 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) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 78 | $42K |
| Life insurance | USABLE LIFE | 135 | $3K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 142 | $164K |
| Other | USABLE LIFE | 135 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.