| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBENCONCEPTS COMPANY3 | 15305 DALLAS PARKWAY SUITE 800 ADDISON, TX 75001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $11K | $11K | 2.57% |
| EBENCONCEPTS COMPANY3 | 639 EXECUTIVE PLACE SUITE 202 FAYETTEVILLE, NC 28305 | STARMOUNT LIFE INSURANCE COMPANY | — | $2K | $2K | 2.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NORTH CAR EIN 56-0894904 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $645K |
| VICKERY FAMILY MEDICINE ONSITE MEDICAL CLINIC | Other fees Service code 99 | 15 GRIFFING BLVD. ASHEVILLE, NC 28804 | $183K |
| WILD HEALTH EIN 20-2969654 ONSITE MEDICAL CLINIC | Other fees Service code 99 | — | $140K |
| EBENCONCEPTS COMPANY EIN 75-2966596 CONSULTANT | Consulting fees; Consulting (general) Service code 16 | — | $60K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $35K |
| RANGE URGENT CARE PLLC EIN 81-4367173 AFTER HOURS MED SUPPORT | Other fees Service code 99 | — | $9K |
| SONA PHARMACY, INC. EIN 20-2939130 RX SUPPORT | Claims processing Service code 12 | — | $5K |
| COLOR GENOMICS, INC EIN 46-3353585 SERVICE PROVIDER | Other fees Service code 99 | — | $796 |
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 | 894 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 894 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 684 | $65K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 894 | $597K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 894 | $446K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 894 | $446K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | 785 | $1.5M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 894 | $446K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 894 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.