| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOSAIC GROUP SERVICES3 | 1822-B N VIRGINIA DARE TRAIL KILL DEVIL HILLS, NC 27948 | USABLE LIFE | $2K | $0 | $2K | 5.00% |
| MAIN STREET FINANCIAL GROUP3 Filed as: MAIN STREET INSURANCE GROUP | 123 E MAIN STREET FOREST CITY, NC 28043 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 14.64% |
| MOSAIC GROUP SERVICES3 | 1822-B N VIRGINIA DARE TRAIL KILL DEVIL HILLS, NC 27948 | USABLE LIFE | $2K | $0 | $2K | 5.00% |
| MOSAIC GROUP SERVICES3 | 1822-B N VIRGINIA DARE TRAIL KILL DEVIL HILLS, NC 27948 | USABLE LIFE | $2K | $0 | $2K | 10.00% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES SE INC | 1901 ROXBOROUGH ROAD SUITE 300 CHARLOTTE, NC 28211 | USABLE LIFE | $0 | $45 | $45 | 0.23% |
| MOSAIC GROUP SERVICES3 | 1822-B N VIRGINIA DARE TRAIL KILL DEVIL HILLS, NC 27948 | USABLE LIFE | $218 | $0 | $218 | 10.02% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICES SE INC | 1901 ROXBOROUGH ROAD SUITE 300 CHARLOTTE, NC 28211 | USABLE LIFE | $0 | $5 | $5 | 0.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NC EIN 56-0894904 MEDICAL TPA | Insurance agents and brokers Service code 22 | — | $102K |
| MARC STEVENS BROKER | Insurance agents and brokers Service code 22 | 11529 WILMAR BLVD CHARLOTTE, NC 28273 | $39K |
| FLORES AMD ASSOCIATES EIN 56-1542307 FSA ADMIN | Claims processing Service code 12 | — | $5K |
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 | 143 | 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) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 91 | $11K |
| Life insurance | USABLE LIFE | 143 | $48K |
| Long-term disability | USABLE LIFE | 140 | $35K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 149 | $333K |
| Other(4 contracts, 2 carriers) | USABLE LIFE | 157 | $104K |
| 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.