| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBENCONCEPTS COMPANY3 | 3150 NORTH ELM STE 201 GREENSBORO, NC 27408 | HEALTHKEEPERS, INC. | $672 | — | $672 | 2.07% |
| CAROLINA BENEFIT SOLUTIONS, INC.3 Filed as: CAROLINA BENEFIT SOLUTIONS INC. | 12833 RIVER DANCE DRIVE RALEIGH, NC 27613 | HEALTHKEEPERS, INC. | $191 | — | $191 | 0.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA EIN 54-0357120 ADMINISTRATIVE AGREEMENT | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing; Other services Service code 12 | — | $12K |
| HEALTHKEEPERS, INC. EIN 54-1356687 ADMINISTRATIVE AGREEMENT | Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $3K |
| CAROLINA BENEFIT SOLUTIONS INC BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 12833 RIVER DANCE DR RALEIGH, NC 27613 | $0 |
| EBENCONCEPTS COMPANY BROKER | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | 3150 NORTH ELM STE 201 GREENSBORO, NC 27408 | $0 |
| INGENIORX, INC. EIN 82-3062245 PBM | Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $0 |
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 | 21 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 21 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHKEEPERS, INC. | 18 | $32K |
| Dental | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 21 | $9K |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 21 | $9K |
| Stop-loss / reinsurancereinsurance | HEALTHKEEPERS, INC. | 18 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 21 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.